Provider Demographics
NPI:1902209562
Name:WILONS, EVAN MATTHEW (LAC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:MATTHEW
Last Name:WILONS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-2430
Mailing Address - Country:US
Mailing Address - Phone:501-663-6771
Mailing Address - Fax:501-663-6458
Practice Address - Street 1:6100 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-2430
Practice Address - Country:US
Practice Address - Phone:501-663-6771
Practice Address - Fax:501-663-6458
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1503043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health