Provider Demographics
NPI:1083612766
Name:WILLCOTT, EARLINE F (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EARLINE
Middle Name:F
Last Name:WILLCOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58482
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77258-8482
Mailing Address - Country:US
Mailing Address - Phone:281-218-7346
Mailing Address - Fax:281-286-3015
Practice Address - Street 1:1322 SPACE PARK DR
Practice Address - Street 2:SUITE C105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:281-218-7346
Practice Address - Fax:281-286-3015
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04780101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0052CYOtherBLUE CROSS BLUE SHIELD
TXS69504OtherMAGELLAN
TX0052CYOtherBLUE CROSS BLUE SHIELD