Provider Demographics
NPI:1891578779
Name:WILSON, SANDRA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-7621
Mailing Address - Country:US
Mailing Address - Phone:832-577-9585
Mailing Address - Fax:
Practice Address - Street 1:1120 NASA PKWY # 609
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3320
Practice Address - Country:US
Practice Address - Phone:832-577-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional