Most Relevant Information
Provider Data
| NPI Number: | 1003579764 |
| Provider Name: | TAKISHA WILSON LGPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | LGP117688 |
Most Important Dates
| Enumeration Date: | 10/20/2021 |
| Last Updated: | 10/20/2021 |
Provider Practice Location
9627 PHILADELPHIA RD STE 160
ROSEDALE
MD
212374157
Practice Location Phone/Fax
| Phone: | 4107805203 |
| Fax: |
Provider Mailing Location
9627 PHILADELPHIA RD STE 160
ROSEDALE
MD
212374157
Provider Mailing Phone/Fax
| Phone: | 4107805203 |
| Fax: |