Provider Demographics
NPI:1841712031
Name:WILSON, SYBIL W
Entity type:Individual
Prefix:MS
First Name:SYBIL
Middle Name:W
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 W BAMBOO DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5822
Mailing Address - Country:US
Mailing Address - Phone:504-701-1067
Mailing Address - Fax:
Practice Address - Street 1:3820 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6037
Practice Address - Country:US
Practice Address - Phone:504-324-5648
Practice Address - Fax:504-324-8692
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA64031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical