Healthcare Provider Details

I. General information

NPI: 1528371127
Provider Name (Legal Business Name): ERIK A. WILSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 S CARAWAY RD STE M
JONESBORO AR
72401-6234
US

IV. Provider business mailing address

1600 ALDERSGATE RD STE 200
LITTLE ROCK AR
72205-6676
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-3757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1609128
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: