Provider Demographics
NPI:1134237647
Name:WILCOX-IRVIN, KARIN RINER (LPC)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:RINER
Last Name:WILCOX-IRVIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 AMITY RD
Mailing Address - Street 2:SUITE 608
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5964
Mailing Address - Country:US
Mailing Address - Phone:501-205-0253
Mailing Address - Fax:501-205-0253
Practice Address - Street 1:505 AMITY RD
Practice Address - Street 2:SUITE 608
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5964
Practice Address - Country:US
Practice Address - Phone:501-205-0253
Practice Address - Fax:501-205-0253
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0805042101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health