Provider Demographics
NPI:1174005078
Name:WILCOX, MARGUERITE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:WILCOX
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 1:117 WILDERNESS DR
Mailing Address - Street 2:
Mailing Address - City:BOYCE
Mailing Address - State:LA
Mailing Address - Zip Code:71409-8608
Mailing Address - Country:US
Mailing Address - Phone:318-451-3541
Mailing Address - Fax:
Practice Address - Street 1:703 VERSAILLES BLVD STE C
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2327
Practice Address - Country:US
Practice Address - Phone:318-451-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA135651041C0700X
FLSW33941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA13565OtherLCSW
FLSW3394OtherLICENSE