Provider Demographics
NPI:1740759802
Name:WILCOX, CATRINA DENISE (CIT)
Entity Type:Individual
Prefix:
First Name:CATRINA
Middle Name:DENISE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 CONNELL PARK LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6534
Mailing Address - Country:US
Mailing Address - Phone:225-300-4850
Mailing Address - Fax:225-258-7098
Practice Address - Street 1:624 CONNELL PARK LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6534
Practice Address - Country:US
Practice Address - Phone:225-300-4850
Practice Address - Fax:225-258-7098
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA8050569Medicaid