Provider Demographics
NPI:1306348404
Name:WILSON, EMILY (LISW-S)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 OLENTANGY RIVER RD.
Mailing Address - Street 2:BLDG D, SUITE 207
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1486
Mailing Address - Country:US
Mailing Address - Phone:614-642-4932
Mailing Address - Fax:
Practice Address - Street 1:3600 OLENTANGY RIVER RD.
Practice Address - Street 2:BLDG D, SUITE 207
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1486
Practice Address - Country:US
Practice Address - Phone:614-642-4932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1901720-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.1901720-SUPVOtherCOUNSELOR , SOCIAL WORKER AND MFT BOARD