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NPI Code Detail

MEDICARE: MR. WOODROW WILSON III LPC

MEDICARE: MR. WOODROW WILSON III LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YP2500XProfessional CounselorP1012081AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992087589
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WOODROW WILSON III LPC
Provider Business Mailing Address
First Line : PO BOX 11064
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-1001
Country : US
Telephone Number : 870-520-5014
Fax Number :
Provider Business Practice Location Address
First Line : 3305 E HIGHLAND DR STE B
Second Line :
City : JONESBORO
State : AR
Zip : 72401-6491
Country : US
Telephone Number : 870-520-5014
Fax Number : 870-520-5015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2011
Last Update Date : 06/26/2025

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Directions to “ MR. WOODROW WILSON III LPC” Practice Location

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