Provider Demographics
NPI:1346486834
Name:WILSON, ELAINE MARIE (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E KIEHL AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-2963
Mailing Address - Country:US
Mailing Address - Phone:501-599-7575
Mailing Address - Fax:501-436-0906
Practice Address - Street 1:208 E KIEHL AVE STE 120
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2963
Practice Address - Country:US
Practice Address - Phone:501-599-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7802-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7990634OtherAETNA
MD7990634OtherAETNA