Provider Demographics
NPI:1417326273
Name:WILSON, NATASCHA MONIQUE (PH D, LPC)
Entity Type:Individual
Prefix:
First Name:NATASCHA
Middle Name:MONIQUE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PH D, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30826 LINDER RD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-8507
Mailing Address - Country:US
Mailing Address - Phone:225-665-7878
Mailing Address - Fax:225-665-7856
Practice Address - Street 1:30826 LINDER RD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-8507
Practice Address - Country:US
Practice Address - Phone:225-665-7878
Practice Address - Fax:225-665-7856
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional