Individual
GREGORY MACLEAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MDIV, MSS, LCSW
Contact information
Practice address
3625 CHAPEL RD, NEWTOWN SQUARE, PA 19073-3602
(484) 427-4673
Mailing address
3625 CHAPEL RD, NEWTOWN SQUARE, PA 19073-3602
(484) 427-4673
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
SW130059
PA
101YA0400X
Addiction (Substance Use Disorder) Counselor
SW130059
PA
101YM0800X
Mental Health Counselor
SW130059
PA
104100000X
Social Worker
Primary
SW130059
PA
Other
Enumeration date
08/10/2015
Last updated
04/19/2017
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