Provider Demographics
NPI:1861643652
Name:WILCOCK, EDWARD KEVIN (LCSW LCDC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:KEVIN
Last Name:WILCOCK
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Gender:M
Credentials:LCSW LCDC
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Mailing Address - Street 1:697 LOUISIANA DRIVE
Mailing Address - Street 2:7TH MEDICAL GROUP
Mailing Address - City:ABILENE DYESS AIR FORCE BASE
Mailing Address - State:TX
Mailing Address - Zip Code:79607-1367
Mailing Address - Country:US
Mailing Address - Phone:325-320-3988
Mailing Address - Fax:325-696-5579
Practice Address - Street 1:697 LOUISIANA DRIVE
Practice Address - Street 2:7TH MEDICAL GROUP
Practice Address - City:ABILENE DYESS AIR FORCE BASE
Practice Address - State:TX
Practice Address - Zip Code:79607-1367
Practice Address - Country:US
Practice Address - Phone:325-320-3988
Practice Address - Fax:325-696-5579
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX5607101YA0400X
TX165711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)