Individual
MISS HEATHER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LCADC, CCTP
Contact information
Practice address
1387 CHEWS LANDING RD, LAUREL SPRINGS, NJ 08021-2760
(855) 765-6399
Mailing address
1387 CHEWS LANDING RD, LAUREL SPRINGS, NJ 08021-2760
(856) 812-5503
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00294200
NJ
101YM0800X
Mental Health Counselor
Primary
44SC05827400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124663059
N/A
NJ
Enumeration date
03/30/2020
Last updated
03/30/2020
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