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General NPI Number Information
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NPI Number | 1083612766
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Entity Type | Individual
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Provider Name | EARLINE F WILLCOTT LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 1322 SPACE PARK DR SUITE C105
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City | HOUSTON
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State | TX
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Zip | 77058
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Country | US
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Telephone | 281-218-7346
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Fax | 281-286-3015
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Provider Business Mailing Address
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Address Line | PO BOX 58482
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City | HOUSTON
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State | TX
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Zip | 77258-8482
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Country | US
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Telephone | 281-218-7346
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Fax | 281-286-3015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 04780
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License Number State | TX
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