Provider Demographics
NPI:1801098686
Name:WILSON, LUCINDA GALLANT (BS)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:GALLANT
Last Name:WILSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:LUCINDA
Other - Last Name:GALLANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2409 HOMER CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2207
Mailing Address - Country:US
Mailing Address - Phone:256-582-3203
Mailing Address - Fax:253-582-3216
Practice Address - Street 1:2409 HOMER CLAYTON DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2207
Practice Address - Country:US
Practice Address - Phone:256-582-3203
Practice Address - Fax:253-582-3216
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator