Provider Demographics
NPI:1851008502
Name:WILSON, MARSHA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 W CHANDLER BLVD APT 2014
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1893
Mailing Address - Country:US
Mailing Address - Phone:573-353-2039
Mailing Address - Fax:
Practice Address - Street 1:3950 W CHANDLER BLVD APT 2014
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1893
Practice Address - Country:US
Practice Address - Phone:573-353-2039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health