Provider Demographics
NPI:1295212678
Name:WILSON, ALLANDA MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:ALLANDA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MARAIS ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-3378
Mailing Address - Country:US
Mailing Address - Phone:504-390-8797
Mailing Address - Fax:
Practice Address - Street 1:701 LOYOLA AVE STE 106
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113
Practice Address - Country:US
Practice Address - Phone:504-558-9595
Practice Address - Fax:504-558-9599
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14997104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker