Colleen Wilcox, LCPC

Key facts

NPI

1700398641

Entity type

Individual (NPI type 1)

Primary specialty

Professional Counselor 101YP2500X

License

LC7834 (MD)

Practice address

1110 Benfield Blvd Ste H
Millersville, MD 21108-2644

Phone

(410) 987-3448

NPI assigned

Nov 1, 2017

Sex

Female

Sole proprietor

No

Organizations & group practices 2

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.

• Permanente Medical Group Inc Internal Medicine Physician · Santa Clara, CA · NPI 1073606299
  Medicare reassignment NPD CA
• Permanente Medical Group, Inc Clinical Medical Laboratory · San Jose, CA · NPI 1497971584
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 1, 2017.

{
    "created_epoch": "1509494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509494400000",
    "number": "1700398641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7501 TRAFALGAR CIR APT 250",
            "city": "HANOVER",
            "state": "MD",
            "postal_code": "210765017",
            "telephone_number": "443-852-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 BENFIELD BLVD STE H",
            "city": "MILLERSVILLE",
            "state": "MD",
            "postal_code": "211082644",
            "telephone_number": "410-987-3448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCOX",
        "first_name": "COLLEEN",
        "name_prefix": "Ms.",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-01",
        "last_updated": "2017-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC7834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peter Charles Wilcox, LCSW C
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All providers in Millersville, MD · Professional Counselor in Maryland