Provider Demographics
NPI:1699499111
Name:WILSON, LORI ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARENDON
Mailing Address - State:AR
Mailing Address - Zip Code:72029-2706
Mailing Address - Country:US
Mailing Address - Phone:870-747-3381
Mailing Address - Fax:870-747-5555
Practice Address - Street 1:1940 S WHITEHEAD DR
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2906
Practice Address - Country:US
Practice Address - Phone:870-946-4505
Practice Address - Fax:870-946-3357
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2209005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional