Devetta Shaunta Wilson, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LC14542 Issued in MD

Practice address

6030 Marshalee Dr Ste M114
Elkridge, MD 21075-5987

Phone

(443) 591-0202

NPI assigned

Dec 1, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wilson Wellness Center, LLC

  • Professional Counselor
  • Elkridge, MD
  • NPI 1235999244
  NPD Authorized official

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1033877618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 HOWARD MANOR DR",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210608260",
            "telephone_number": "443-591-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6030 MARSHALEE DR STE M114",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210755987",
            "telephone_number": "443-591-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DEVETTA",
        "middle_name": "SHAUNTA",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-01",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC14542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khiarra Watkins, PHARMD
• Beth Whiteford, CRNP
• William a Gormley, DPM, LLC
• Calista Williams, PHARM.D.
• Wilson Wellness Center, LLC
• Jill Holen Witkin, LMT
• Dina Wolfe, R.PH.
• Erica Wright
• Giavaun Marshay Young, LMSW
• Rania Hassan Younis, BDS,MDS,PHD

• Professional Counselor in Elkridge, MD
• Providers in Elkridge, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.