Provider Demographics
NPI:1275072126
Name:WILSON, ERIN (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8987 E TANQUE VERDE RD STE 309-1030
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9610
Mailing Address - Country:US
Mailing Address - Phone:520-909-5650
Mailing Address - Fax:520-509-4496
Practice Address - Street 1:8987 E TANQUE VERDE RD STE 309-1030
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9610
Practice Address - Country:US
Practice Address - Phone:520-909-5650
Practice Address - Fax:520-509-4496
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-165481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ255706Medicaid