Provider Demographics
NPI:1114217809
Name:WILLSON, STELLA INGRID (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:INGRID
Last Name:WILLSON
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 1:7101 VIRGINIA PKWY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5753
Mailing Address - Country:US
Mailing Address - Phone:214-643-3411
Mailing Address - Fax:
Practice Address - Street 1:7101 VIRGINIA PKWY
Practice Address - Street 2:#843
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5753
Practice Address - Country:US
Practice Address - Phone:214-643-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX524621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical