Provider Demographics
NPI:1881195535
Name:WILSON, ZENOBIA JEANETTE (MHS)
Entity Type:Individual
Prefix:MS
First Name:ZENOBIA
Middle Name:JEANETTE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2204
Mailing Address - Country:US
Mailing Address - Phone:318-614-8972
Mailing Address - Fax:
Practice Address - Street 1:1416 NATCHITOCHES ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-3751
Practice Address - Country:US
Practice Address - Phone:318-855-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1881195535Medicaid