Provider Demographics
NPI:1760652739
Name:WILSON, GAIL M (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4539
Mailing Address - Country:US
Mailing Address - Phone:410-538-3805
Mailing Address - Fax:
Practice Address - Street 1:4 NORTH AVENUE
Practice Address - Street 2:SUITE 306
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-0000
Practice Address - Country:US
Practice Address - Phone:410-420-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional