Provider Demographics
NPI:1942315494
Name:WILSON, ANTHONY CHRISTOPHER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CHRISTOPHER
Last Name:WILSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:655 7TH ST BLDG 700700-A
Mailing Address - Street 2:78 MDG/SGOW
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098-2227
Mailing Address - Country:US
Mailing Address - Phone:478-327-8403
Mailing Address - Fax:478-327-8400
Practice Address - Street 1:7300 N PERIMETER RD
Practice Address - Street 2:BLDG 2040
Practice Address - City:MALMSTROM AFB
Practice Address - State:MT
Practice Address - Zip Code:59402-6701
Practice Address - Country:US
Practice Address - Phone:406-731-3219
Practice Address - Fax:406-731-3231
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCLC500786601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical