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Individual
MR. MICHAEL R WILSON
Active
Individual
MR. MICHAEL R WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, BCD
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904006028
VA
1041C0700X
Clinical Social Worker
149-003009
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945018
—
VA
Enumeration date
05/23/2007
Last updated
04/20/2011
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