Provider Demographics
NPI:1528415759
Name:WILSON, EMILY (BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 LAURENT CIR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2514
Mailing Address - Country:US
Mailing Address - Phone:757-330-5700
Mailing Address - Fax:
Practice Address - Street 1:763 J CLYDE MORRIS BLVD STE 1C
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1533
Practice Address - Country:US
Practice Address - Phone:757-524-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000152103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst