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Individual

WILSON A LLERENA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LGMFT

Contact information

Practice address
319 W PATRICK ST, FREDERICK, MD 21701-4855
(301) 640-5702
(443) 331-4441
Mailing address
319 W PATRICK ST, FREDERICK, MD 21701-4855
(301) 640-5702
(443) 331-4441

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LCM811
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
LGM712
MD
Enumeration date
01/29/2019
Last updated
02/02/2024
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