Provider Demographics
NPI:1851304810
Name:WILSON, WILLIAM ALEXANDER (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:WILSON
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 RICHARDS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2650
Mailing Address - Country:US
Mailing Address - Phone:501-753-1616
Mailing Address - Fax:501-753-8471
Practice Address - Street 1:4020 RICHARDS RD
Practice Address - Street 2:SUITE F
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2650
Practice Address - Country:US
Practice Address - Phone:501-753-1616
Practice Address - Fax:501-753-8471
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8709020101YP2500X
ARM9710029106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S858OtherBC/BS PROVIDER NUMBER