Provider Demographics
NPI:1972677789
Name:WILSON, PATRICIA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
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 1:8109 HARFORD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-9205
Mailing Address - Country:US
Mailing Address - Phone:410-665-2900
Mailing Address - Fax:
Practice Address - Street 1:8109 HARFORD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-9205
Practice Address - Country:US
Practice Address - Phone:410-665-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD091491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical