Provider Demographics
NPI:1821122359
Name:WILSON, SHEILA CARNES (LCSW)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:CARNES
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 1:852 GREENHILLS DR SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-6004
Mailing Address - Country:US
Mailing Address - Phone:256-328-4744
Mailing Address - Fax:423-507-8791
Practice Address - Street 1:744 TELL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3148
Practice Address - Country:US
Practice Address - Phone:423-507-8826
Practice Address - Fax:423-507-8791
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2082C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51539253OtherBCBS
AL510I800008Medicare PIN