Provider Demographics
NPI:1689932790
Name:WILCOX, LANA DORIS
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:DORIS
Last Name:WILCOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 N BERTRAND ST
Mailing Address - Street 2:UNIT 309
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-6800
Mailing Address - Country:US
Mailing Address - Phone:865-250-7996
Mailing Address - Fax:
Practice Address - Street 1:523 N BERTRAND ST
Practice Address - Street 2:UNIT 309
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6800
Practice Address - Country:US
Practice Address - Phone:865-250-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health