Provider Demographics
NPI:1992218374
Name:WILSON, THOMAS W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:WILSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 MILLENIA BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6019
Mailing Address - Country:US
Mailing Address - Phone:970-930-1264
Mailing Address - Fax:970-431-2327
Practice Address - Street 1:4700 MILLENIA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6019
Practice Address - Country:US
Practice Address - Phone:970-930-1264
Practice Address - Fax:970-431-2327
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099254471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical