Provider Demographics
NPI:1659662138
Name:WILSON, AARON JAMES (LMSW)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:JAMES
Last Name:WILSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 EAGLE RUN DR NE
Mailing Address - Street 2:STE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7070
Mailing Address - Country:US
Mailing Address - Phone:616-365-8920
Mailing Address - Fax:616-365-8971
Practice Address - Street 1:3351 EAGLE RUN DR NE
Practice Address - Street 2:STE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7070
Practice Address - Country:US
Practice Address - Phone:616-365-8920
Practice Address - Fax:616-365-8971
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091283104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker