Provider Demographics
NPI:1932132966
Name:WILCOX, PETER CHARLES (LCSW C)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:CHARLES
Last Name:WILCOX
Suffix:
Gender:M
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 1:1110 BENFIELD BLVD
Mailing Address - Street 2:STE H I97 BUSINESS PK SEVERNA PARK PROFESSIONAL COUNSEL
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2540
Mailing Address - Country:US
Mailing Address - Phone:410-987-5048
Mailing Address - Fax:410-987-4710
Practice Address - Street 1:1110 BENFIELD BLVD
Practice Address - Street 2:STE H I97 BUSINESS PK SEVERNA PARK PROFESSIONAL COUNSEL
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2540
Practice Address - Country:US
Practice Address - Phone:410-987-5048
Practice Address - Fax:410-987-4710
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD061981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical