Provider Demographics
NPI:1992020572
Name:WILSON, HEIDI ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:ANN
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 1:5051 CASTELLO DR STE 204
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-8985
Mailing Address - Country:US
Mailing Address - Phone:239-260-4387
Mailing Address - Fax:844-715-9627
Practice Address - Street 1:5051 CASTELLO DR STE 204
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8985
Practice Address - Country:US
Practice Address - Phone:239-260-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW92931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720526387OtherGROUP