Individual
DR. RICHARD WILLIAM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC LMFT
Contact information
Practice address
4914 RADFORD AVE, STE 207, RICHMOND, VA 23230-3538
(804) 257-9556
Mailing address
PO BOX 35395, RICHMOND, VA 23235-0395
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0701003716
VA
106H00000X
Marriage & Family Therapist
0717001088
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010203163
—
VA
01
—
181219
BCBS
VA
01
—
182885
BCBS
VA
01
—
324642
TRICARE
VA
01
—
498920
VALUEOPTIONS
VA
01
—
74653000
MAGELLAN
VA
01
—
O81645M
OPTIMA
VA
Enumeration date
12/21/2005
Last updated
05/26/2008
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