Provider Demographics
NPI:1528444858
Name:WILSON, GREGORY MACLEAN (MDIV, MSS, LCSW)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MACLEAN
Last Name:WILSON
Suffix:
Gender:M
Credentials:MDIV, MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3602
Mailing Address - Country:US
Mailing Address - Phone:484-427-4673
Mailing Address - Fax:
Practice Address - Street 1:3625 CHAPEL RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3602
Practice Address - Country:US
Practice Address - Phone:484-427-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130059101Y00000X, 101YA0400X, 101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health