Individual
MR. CHARLES H WILSON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHP-R
Contact information
Practice address
13400 EDGEMEADE RD, UPPER MARLBORO, MD 20772-8088
(301) 358-0192
Mailing address
9355 TARTAN VIEW DR, FAIRFAX, VA 22032-1207
(571) 346-9437
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0704013703
VA
Other
Enumeration date
04/23/2021
Last updated
04/23/2021
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