| Doctor Name: | MICHAEL D WILSON |
| NPI Number: | 1629130067 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA,MDIV,CEAP,LPC |
| License Number: | 37PC00053700 |
| Business Practice Address: | 3 Alexandra Ln Long Valley, NJ - 078533458 |
| Business Phone Number: | 9088765693 |
| Business Fax Number: | |
| Mailing Address: | 3 Alexandra Ln, LONG VALLEY |
| State: | NJ |
| Postal Code: | 078533458 |
| Phone Number: | 9088765693 |
| Fax Number: | |
| NPI Enumeration Date: | 12/14/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 37PC00053700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |