Provider Demographics
NPI:1396191383
Name:WILSON, LUCINDA HOLMES (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LUCINDA
Middle Name:HOLMES
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 WHITNEY AVE
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5011
Mailing Address - Country:US
Mailing Address - Phone:504-347-1120
Mailing Address - Fax:504-347-1782
Practice Address - Street 1:1141 WHITNEY AVE
Practice Address - Street 2:BUILDING 4
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5011
Practice Address - Country:US
Practice Address - Phone:504-347-1120
Practice Address - Fax:504-347-1782
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12839101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)