| Doctor Name: | DR. RAYMOND JOHN WILSON |
| NPI Number: | 1447217443 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 03478 |
| Business Practice Address: | 84 Neptune Dr Joppa, MD - 210854539 |
| Business Phone Number: | 4105383805 |
| Business Fax Number: | 4105384057 |
| Mailing Address: | 84 Neptune Dr, JOPPA |
| State: | MD |
| Postal Code: | 210854539 |
| Phone Number: | 4105383805 |
| Fax Number: | 4105384057 |
| NPI Enumeration Date: | 04/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | 03478 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |