Jennifer Wilson Lcswc Lcadc LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

18028 Issued in MD

Legal business name

JENNIFER WILSON LCSWC LCADC LLC

Practice address

9199 Reisterstown Rd Ste 202B
Owings Mills, MD 21117-4579

Phone

(410) 868-0001

NPI assigned

Sep 3, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jennifer W Wilson, LCSWC, LCADC

Title

Owner

Phone

(410) 868-0001

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677801600000",
    "number": "1033691407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16528 FALLS RD",
            "city": "UPPERCO",
            "state": "MD",
            "postal_code": "211559483",
            "telephone_number": "410-868-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9199 REISTERSTOWN RD STE 202B",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174579",
            "telephone_number": "410-868-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER WILSON LCSWC LCADC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-03",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-868-0001",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSWC, LCADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "LCA2105",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "18028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.