Provider Demographics
NPI:1003525916
Name:WILSON, ALORA ELIZABETH I
Entity Type:Individual
Prefix:
First Name:ALORA
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 SANALOMA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1759
Mailing Address - Country:US
Mailing Address - Phone:512-639-1468
Mailing Address - Fax:
Practice Address - Street 1:4861 WILLIAMS DR STE 101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-2425
Practice Address - Country:US
Practice Address - Phone:737-295-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician