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General NPI Number Information
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NPI Number | 1871990598
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Entity Type | Organization
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Legal Business Name | DONNA J WILSON, LCSW, PLLC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 73 PIEDMONT DR
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City | WHITESBURG
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State | KY
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Zip | 41858-7668
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Country | US
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Telephone | 727-538-4208
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Fax | 866-341-7509
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Provider Business Mailing Address
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Address Line | 114 PICARDY CT
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-3132
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Country | US
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Telephone | 727-538-4208
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Fax | 866-341-7509
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Authorized Official
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Title or Position | OWNER
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Name | DONNA J WILSON
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Credential | LCSW
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Telephone | 727-538-4208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3839
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License Number State | KY
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