Provider Demographics
NPI:1194827717
Name:WILSON, ADRIENE ANA (MSW, LCSW,)
Entity Type:Individual
Prefix:MS
First Name:ADRIENE
Middle Name:ANA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW, LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1503
Mailing Address - Country:US
Mailing Address - Phone:210-617-5113
Mailing Address - Fax:
Practice Address - Street 1:5788 ECKHERT RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3900
Practice Address - Country:US
Practice Address - Phone:210-699-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX397341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX671OtherAUDIE L. MURPHYVAHOSPITAL