Individual
REVA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1516 NORTHERN LIGHTS DR, UPPER MARLBORO, MD 20774-6094
(407) 408-4518
Mailing address
1516 NORTHERN LIGHTS DR, UPPER MARLBORO, MD 20774-6094
(407) 408-4518
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10186
VA
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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