Provider Demographics
NPI:1477949337
Name:WIMSATT, WILLIAM EDWARD JR (LCSW, CAC III)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:WIMSATT
Suffix:JR
Gender:M
Credentials:LCSW, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 28 RD
Mailing Address - Street 2:BLDG A, SUITE 201
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6556
Mailing Address - Country:US
Mailing Address - Phone:970-462-7717
Mailing Address - Fax:
Practice Address - Street 1:518 28 RD
Practice Address - Street 2:BLDG A, SUITE 201
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6556
Practice Address - Country:US
Practice Address - Phone:970-462-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7079101YA0400X
CO7531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)