Healthcare Provider Details

I. General information

NPI: 1578439709
Provider Name (Legal Business Name): LAUREN WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7417 KINGSTON PIKE STE 201
KNOXVILLE TN
37919-5680
US

IV. Provider business mailing address

3713 TERRACE VIEW DR
KNOXVILLE TN
37918-3448
US

V. Phone/Fax

Practice location:
  • Phone: 703-861-9862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7114
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: