| Doctor Name: | JEANINE MICHELLE WILSON |
| NPI Number: | 1033418611 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | LC50078965 |
| Business Practice Address: | 4809 Colonel Brooke Ct Upper Marlboro, MD - 207722872 |
| Business Phone Number: | 4105078183 |
| Business Fax Number: | 3017803271 |
| Mailing Address: | 4809 Colonel Brooke Ct, UPPER MARLBORO |
| State: | MD |
| Postal Code: | 207722872 |
| Phone Number: | 4105078183 |
| Fax Number: | 3017803271 |
| NPI Enumeration Date: | 03/22/2011 |
| NPI Last Update Date: | 03/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LC50078965 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | DC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |