Provider Demographics
NPI:1457434391
Name:WILSON-HARGROVE, WENDY (LCSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WILSON-HARGROVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:VANNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0614
Mailing Address - Country:US
Mailing Address - Phone:270-886-2205
Mailing Address - Fax:270-886-0392
Practice Address - Street 1:735 NORTH DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2620
Practice Address - Country:US
Practice Address - Phone:270-886-5163
Practice Address - Fax:270-886-5178
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3048104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker