Provider Demographics
NPI:1710443684
Name:WILSON, SARAH LINFIELD (P-LPC, MAMFT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LINFIELD
Last Name:WILSON
Suffix:
Gender:F
Credentials:P-LPC, MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 EBENEZER BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6002
Mailing Address - Country:US
Mailing Address - Phone:601-790-0583
Mailing Address - Fax:
Practice Address - Street 1:940 EBENEZER BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6002
Practice Address - Country:US
Practice Address - Phone:601-790-0583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health