Individual
DR. RICHARD WILLIAM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC LMFT
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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