Individual
MRS. LAGAIL JEANEAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMFT
Contact information
Practice address
15717 CRABBS BRANCH WAY STE 229, ROCKVILLE, MD 20855-6650
(301) 637-2792
(844) 375-0213
Mailing address
17604 PHELPS HILL LN, DERWOOD, MD 20855-1358
(913) 963-7133
(844) 375-0213
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
2794
KS
106H00000X
Marriage & Family Therapist
2852
KS
106H00000X
Marriage & Family Therapist
Primary
LCM756
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201229790A
—
KS
Enumeration date
09/15/2016
Last updated
02/18/2020
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