Provider Demographics
NPI:1518225499
Name:WILSON, ANITA KAY (LADAC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:KAY
Last Name:WILSON
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015
Mailing Address - Country:US
Mailing Address - Phone:615-319-4386
Mailing Address - Fax:
Practice Address - Street 1:1881 GENERAL GEORGE PATTON DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-4606
Practice Address - Country:US
Practice Address - Phone:615-829-5700
Practice Address - Fax:615-661-4357
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000000327101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)