Provider Demographics
NPI:1184852832
Name:WILSON, ADRIENNE CAROL (LPCC)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:CAROL
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3172 RIO ARRIZA LOOP
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7689
Mailing Address - Country:US
Mailing Address - Phone:575-373-1163
Mailing Address - Fax:575-373-1164
Practice Address - Street 1:3172 RIO ARRIZA LOOP
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7689
Practice Address - Country:US
Practice Address - Phone:575-373-1163
Practice Address - Fax:575-373-1164
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0122051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health