1699049346 NPI number — MS. MARCIA ANNMARIE WILMOT MA, NCC, LCPC

Table of content: MS. MARCIA ANNMARIE WILMOT MA, NCC, LCPC (NPI 1699049346)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699049346 NPI number — MS. MARCIA ANNMARIE WILMOT MA, NCC, LCPC

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
WILMOT

Provider First Name:
MARCIA

Provider Middle Name:
ANNMARIE

Provider Name Prefix Text:
MS.

Provider Name Suffix Text:

Provider Credential Text:
MA, NCC, LCPC

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
WILMOT

Provider Other First Name:
JOY

Provider Other Middle Name:
ANNMARIE

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:
MA, NCC, LCPC

Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699049346

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
02/27/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 QUARTET LN

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
SILVER SPRING

Provider Business Mailing Address State Name:
MD

Provider Business Mailing Address Postal Code:
20904-6823

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
301-890-4210

Provider Business Mailing Address Fax Number:
301-890-3766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5124 DORSEY HALL DR

Provider Second Line Business Practice Location Address:
SUITE 202

Provider Business Practice Location Address City Name:
ELLICOTT CITY

Provider Business Practice Location Address State Name:
MD

Provider Business Practice Location Address Postal Code:
21042-7870

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
301-890-4210

Provider Business Practice Location Address Fax Number:
301-890-3766

Provider Enumeration Date:
02/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 101YP2500X , with the licence number: LC3646 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .