Provider Demographics
NPI:1225003403
Name:WILSON, WILLETTA M (LMFT, LPC, MAC, BC-)
Entity type:Individual
Prefix:
First Name:WILLETTA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT, LPC, MAC, BC-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 TOWNES PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2091
Mailing Address - Country:US
Mailing Address - Phone:703-303-0039
Mailing Address - Fax:
Practice Address - Street 1:A.T. AUGUSTA MILITARY MEDICAL CENTER
Practice Address - Street 2:9300 DEWITT LOOP; RIVER PAVILION
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:571-231-3224
Practice Address - Fax:571-231-6623
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007409101Y00000X
DCPRC13727101YP2500X, 101Y00000X
DCLMFT000060106H00000X
VA0701005368101YP2500X
NJ37LC00106600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist