Provider Demographics
NPI:1992959894
Name:WILSON, LERNARD (MA, LMHC, NCC, CSMS)
Entity type:Individual
Prefix:MR
First Name:LERNARD
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:MA, LMHC, NCC, CSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 NAWADAHA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-5365
Mailing Address - Country:US
Mailing Address - Phone:321-206-6300
Mailing Address - Fax:407-290-9787
Practice Address - Street 1:2210 S RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-5262
Practice Address - Country:US
Practice Address - Phone:321-206-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health