Individual
TAKISHA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGPC
Contact information
Practice address
2714 PRINCESS VICTORIA WAY, BOWIE, MD 20721-2439
(201) 341-0153
Mailing address
2714 PRINCESS VICTORIA WAY, BOWIE, MD 20721-2439
(201) 341-0153
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC16674
MD
Other
Enumeration date
10/20/2021
Last updated
12/30/2025
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