Provider Demographics
NPI:1932575271
Name:WILSON, TORI ANN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:TORI
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:TORI
Other - Middle Name:ANN
Other - Last Name:MARNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1330 MCCORMICK DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5398
Mailing Address - Country:US
Mailing Address - Phone:301-772-1200
Mailing Address - Fax:301-386-4479
Practice Address - Street 1:1330 MCCORMICK DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5398
Practice Address - Country:US
Practice Address - Phone:301-772-1200
Practice Address - Fax:301-386-4479
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional