Individual
LISA WILKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LPC, LCPC
Contact information
Practice address
1300 MERCANTILE LN STE 100M, LARGO, MD 20774-5390
(202) 600-1403
Mailing address
1300 MERCANTILE LN, SUITE 100-M, LARGO, MD 20774-5327
(202) 600-1403
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LC7708
MD
101Y00000X
Counselor
PRC14749
DC
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
LC7708
MD
101YM0800X
Mental Health Counselor
PRC14749
DC
101YP2500X
Professional Counselor
LC7708
MD
101YP2500X
Professional Counselor
PRC14749
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LC7708
LCPC
MD
Enumeration date
02/25/2016
Last updated
01/07/2019
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