Provider Demographics
NPI:1740576081
Name:WILSON, MARTHA LOFLIN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LOFLIN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 VINCENT RD APT 1306
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6271
Mailing Address - Country:US
Mailing Address - Phone:225-428-7455
Mailing Address - Fax:225-665-5451
Practice Address - Street 1:904 GOVERNMENT ST.
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726
Practice Address - Country:US
Practice Address - Phone:225-665-7242
Practice Address - Fax:225-665-5451
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA130731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical