Provider Demographics
NPI:1457717829
Name:WILSON, JOSH (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:WILSON
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 1:9701 KEYSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-8619
Mailing Address - Country:US
Mailing Address - Phone:204-401-3062
Mailing Address - Fax:301-515-8360
Practice Address - Street 1:3800 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3618
Practice Address - Country:US
Practice Address - Phone:240-401-3062
Practice Address - Fax:301-515-8360
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD124601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical