Active NPI
Charles H Wilson IV, LMHP-R
- Counselor
- Upper Marlboro, MD
National Provider Identifier
1992387534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 0704013703
- Practice address
- 13400 Edgemeade Rd
Upper Marlboro, MD 20772-8088 - Phone
- (301) 358-0192
- NPI assigned
- Apr 23, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 0704013703 | VA | Primary |
Addresses
Primary practice location
13400 Edgemeade Rd
Upper Marlboro, MD 20772-8088
Mailing address
9355 Tartan View Dr
Fairfax, VA 22032-1207
Phone (571) 346-9437
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0704013703 | VA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619136000000",
"number": "1992387534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9355 TARTAN VIEW DR",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220321207",
"telephone_number": "571-346-9437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13400 EDGEMEADE RD",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207728088",
"telephone_number": "301-358-0192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CHARLES",
"middle_name": "H",
"name_prefix": "Mr.",
"name_suffix": "IV",
"credential": "LMHP-R",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-23",
"last_updated": "2021-04-23",
"certification_date": "2021-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "VA",
"license": "0704013703",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.