Provider Demographics
NPI:1821108671
Name:BARBARA L. WILSON, LCSW, PC
Entity Type:Organization
Organization Name:BARBARA L. WILSON, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-456-3233
Mailing Address - Street 1:PO BOX 80042
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-0042
Mailing Address - Country:US
Mailing Address - Phone:907-456-3233
Mailing Address - Fax:907-456-3233
Practice Address - Street 1:565 UNIVERSITY AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3642
Practice Address - Country:US
Practice Address - Phone:907-456-3233
Practice Address - Fax:907-456-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty