Provider Demographics
NPI:1396307096
Name:WILSON, JASON ELIAS I
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ELIAS
Last Name:WILSON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 26TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2515
Mailing Address - Country:US
Mailing Address - Phone:202-664-3183
Mailing Address - Fax:
Practice Address - Street 1:217 S KING ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2905
Practice Address - Country:US
Practice Address - Phone:703-464-7400
Practice Address - Fax:703-464-0908
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health