Provider Demographics
NPI:1518075514
Name:WILSON, WILLIAM F (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:WILSON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8401 DORSEY CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8303
Mailing Address - Country:US
Mailing Address - Phone:703-330-7377
Mailing Address - Fax:703-330-5925
Practice Address - Street 1:8401 DORSEY CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8303
Practice Address - Country:US
Practice Address - Phone:703-330-7377
Practice Address - Fax:703-330-5925
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional