Provider Demographics
NPI:1417744491
Name:WILSON, SARAH NICOLE (LAC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:
Credentials:LAC
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:NICOLE
Other - Last Name:DOBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2315 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4415
Mailing Address - Country:US
Mailing Address - Phone:870-277-4357
Mailing Address - Fax:
Practice Address - Street 1:2315 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4415
Practice Address - Country:US
Practice Address - Phone:870-277-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR428095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health