| Doctor Name: | BONITA L WILSON |
| NPI Number: | 1508099672 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW C |
| License Number: | 08918 |
| Business Practice Address: | 7200 Third Ave Box 1000 Sykesville, MD - 217841000 |
| Business Phone Number: | 4107958808 |
| Business Fax Number: | 4108221769 |
| Mailing Address: | 7200 Third Ave Box 1000, SYKESVILLE |
| State: | MD |
| Postal Code: | 217841000 |
| Phone Number: | 4107958808 |
| Fax Number: | 4108221769 |
| NPI Enumeration Date: | 08/24/2009 |
| NPI Last Update Date: | 08/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 08918 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |