Provider Demographics
NPI:1093916264
Name:WILSON, MARQUITA D (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7924 LANSDALE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2121
Mailing Address - Country:US
Mailing Address - Phone:443-691-1929
Mailing Address - Fax:410-887-1259
Practice Address - Street 1:7701 SEVEN MILE LN
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4326
Practice Address - Country:US
Practice Address - Phone:410-887-1207
Practice Address - Fax:410-887-1259
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD144311041C0700X
MDG11181104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG11755Medicaid
MD1093916264Medicaid