Heather Wilson, LCSW, LCADC, CCTP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

44SC05827400 Issued in NJ

Practice address

1387 Chews Landing Rd
Laurel Springs, NJ 08021-2760

Phone

(855) 765-6399

NPI assigned

Mar 30, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Victory Bay Recovery Center, LLC

  • Substance Abuse Rehabilitation Facility
  • Laurel Springs, NJ
  • NPI 1700328283
  NPD (past)

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585526400000",
    "number": "1982232674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1387 CHEWS LANDING RD",
            "city": "LAUREL SPRINGS",
            "state": "NJ",
            "postal_code": "080212760",
            "telephone_number": "856-812-5503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1387 CHEWS LANDING RD",
            "city": "LAUREL SPRINGS",
            "state": "NJ",
            "postal_code": "080212760",
            "telephone_number": "855-765-6399"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1395 Chews Landing Rd",
            "address_purpose": "LOCATION",
            "city": "Laurel Springs",
            "state": "NJ",
            "postal_code": "080212760",
            "country_code": "US",
            "telephone_number": "856-282-2050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "HEATHER",
        "name_prefix": "Miss",
        "credential": "LCSW, LCADC, CCTP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-30",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00294200",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "44SC05827400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "1124663059",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victory Bay Recovery Center, LLC
• Kathleen Vitelliviscusi, RT
• Nguyet Vu-Nguyen, D.D.S
• Kelly Elisabeth Walker, RN
• Sharon A. Watson, PHARMD
• Que-CHI Vuong Wong, M.D.
• Poonam Yadav, DMD

• Mental Health Counselor in Laurel Springs, NJ
• Providers in Laurel Springs, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2020; 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.