Provider Demographics
NPI:1699057851
Name:WILSON, CHRISTINE (MS, ATR, LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, ATR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 FINANCIAL CENTRE PKWY STE 290
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3581
Mailing Address - Country:US
Mailing Address - Phone:501-781-2230
Mailing Address - Fax:888-816-7916
Practice Address - Street 1:10800 FINANCIAL CENTRE PKWY STE 290
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3581
Practice Address - Country:US
Practice Address - Phone:501-781-2230
Practice Address - Fax:888-816-7916
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1210100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional