Provider Demographics
NPI:1053559179
Name:WILSON, LINDA MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140901
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214-0901
Mailing Address - Country:US
Mailing Address - Phone:720-318-7321
Mailing Address - Fax:303-955-6721
Practice Address - Street 1:6700 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4732
Practice Address - Country:US
Practice Address - Phone:303-420-8080
Practice Address - Fax:303-420-9299
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional