Individual
DR. MERCEDES E. WILSON DALLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
720 N SAINT ASAPH ST, FOURTH FLOOR, ALEXANDRIA, VA 22314-1912
(703) 838-6400
(703) 838-5070
Mailing address
4906 SHARON RD, CAMP SPRINGS, MD 20748-2236
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001425
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0025
CARE FIRST BCBS
VI
01
—
008746A25
MEDICARE
VA
01
—
188512
ANTHEM
VA
01
—
270291
AMERIGROUP
VA
01
—
546001103002
TRICARE
VA
Enumeration date
01/05/2007
Last updated
07/09/2007
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