Provider Demographics
NPI:1922124064
Name:WILSON, ANNA HEATON (LCSW, PIP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:HEATON
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:HEATON
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, PIP
Mailing Address - Street 1:111 LONGWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4522
Mailing Address - Country:US
Mailing Address - Phone:256-534-8161
Mailing Address - Fax:256-534-7254
Practice Address - Street 1:111 LONGWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4522
Practice Address - Country:US
Practice Address - Phone:256-534-8161
Practice Address - Fax:256-534-7254
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2059C1041C0700X
AL0817-2059C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical