Provider Demographics
NPI:1891099834
Name:WILSON, ASHLEY MONIQUE (LPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MONIQUE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MONIQUE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:GUY
Mailing Address - State:AR
Mailing Address - Zip Code:72061-0352
Mailing Address - Country:US
Mailing Address - Phone:870-897-7023
Mailing Address - Fax:
Practice Address - Street 1:1813 EXECUTIVE SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6086
Practice Address - Country:US
Practice Address - Phone:870-899-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
ARP2006019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist