Provider Demographics
NPI:1972014876
Name:WILSON, SCOT (MS, LCMHC)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3761
Mailing Address - Country:US
Mailing Address - Phone:603-781-2785
Mailing Address - Fax:
Practice Address - Street 1:6 S STATE ST STE 2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3700
Practice Address - Country:US
Practice Address - Phone:603-228-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health