Provider Demographics
NPI:1669131199
Name:ANNA H WILSON, LICSW, PIP, LLC
Entity type:Organization
Organization Name:ANNA H WILSON, LICSW, PIP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER AND OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, PIP
Authorized Official - Phone:205-616-9953
Mailing Address - Street 1:3050 TERESA AVE
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-3043
Mailing Address - Country:US
Mailing Address - Phone:205-616-9953
Mailing Address - Fax:
Practice Address - Street 1:4268 CAHABA HEIGHTS CT STE 132
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5737
Practice Address - Country:US
Practice Address - Phone:205-616-9953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922024064OtherNPI