Provider Demographics
NPI:1154857001
Name:WILSON, ERRIN (BA, SSP)
Entity type:Individual
Prefix:
First Name:ERRIN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:BA, SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3728
Mailing Address - Country:US
Mailing Address - Phone:504-722-0914
Mailing Address - Fax:
Practice Address - Street 1:3330 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6206
Practice Address - Country:US
Practice Address - Phone:504-827-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA432930103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool