Provider Demographics
NPI:1891825048
Name:WILSON, NESSA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:NESSA
Middle Name:MARIE
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 1:367 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-1439
Mailing Address - Country:US
Mailing Address - Phone:541-280-3885
Mailing Address - Fax:
Practice Address - Street 1:2542 NE COURTNEY DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7685
Practice Address - Country:US
Practice Address - Phone:541-549-1318
Practice Address - Fax:541-588-6002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL60271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical