Individual
MRS. SUSAN M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2616 LANGHORNE RD, STE 1, LYNCHBURG, VA 24501-1604
(434) 847-8300
(434) 847-8962
Mailing address
PO BOX 11991, LYNCHBURG, VA 24506-1991
(434) 847-8300
(434) 847-8962
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701002848
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236395
ANTHEM
VA
01
—
473073
VALUE OPTIONS
—
Enumeration date
09/05/2006
Last updated
07/08/2007
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