Doctor Name: | LOURIE W. WILSON |
NPI Number: | 1316150642 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 0701004130 |
Business Practice Address: | 1313 Vincent Place Mclean, VA - 22101 |
Business Phone Number: | 7035173317 |
Business Fax Number: | |
Mailing Address: | 1937 Massachusetts Ave., MCLEAN |
State: | VA |
Postal Code: | 22101 |
Phone Number: | 7035173317 |
Fax Number: | |
NPI Enumeration Date: | 05/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0701004130 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |