Provider Demographics
NPI:1154754828
Name:WILSON, ROBERT A (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:WILSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9316
Mailing Address - Country:US
Mailing Address - Phone:304-623-5661
Mailing Address - Fax:304-623-2989
Practice Address - Street 1:40 COMMERCE DR
Practice Address - Street 2:STE B
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-3874
Practice Address - Country:US
Practice Address - Phone:304-241-1708
Practice Address - Fax:304-391-2054
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WV2044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)