Provider Demographics
NPI:1366738734
Name:TERESA S. WILSON LLC
Entity type:Organization
Organization Name:TERESA S. WILSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:SHARLENE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:410-227-7191
Mailing Address - Street 1:21 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4849
Mailing Address - Country:US
Mailing Address - Phone:410-227-7191
Mailing Address - Fax:
Practice Address - Street 1:1050 17TH ST NW
Practice Address - Street 2:SUITE 1000
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5503
Practice Address - Country:US
Practice Address - Phone:410-227-7191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLMFT000138251S00000X
DCPRC14103251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437450988OtherNPI TYPE 1