Provider Demographics
NPI:1215238761
Name:WILSON, DEBORAH J
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:J
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 STEPHENS HWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:AR
Mailing Address - Zip Code:71758-6095
Mailing Address - Country:US
Mailing Address - Phone:870-554-3122
Mailing Address - Fax:
Practice Address - Street 1:2818 STEPHENS HWY
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:AR
Practice Address - Zip Code:71758-6095
Practice Address - Country:US
Practice Address - Phone:870-554-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARLPE 93-04I103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist