Provider Demographics
NPI:1184829145
Name:WILSON, EMMA HIATT (PHD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:HIATT
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 LEIGHTON AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4610
Mailing Address - Country:US
Mailing Address - Phone:256-238-8113
Mailing Address - Fax:256-238-8955
Practice Address - Street 1:1115 LEIGHTON AVE STE 1A
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4610
Practice Address - Country:US
Practice Address - Phone:256-238-8113
Practice Address - Fax:256-238-8955
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27574103T00000X
1041C0700X
AL2115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical