Provider Demographics
NPI:1972659803
Name:WILSON, JOSHUA A (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:A
Last Name:WILSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 TIFFANIE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-4082
Mailing Address - Country:US
Mailing Address - Phone:859-338-1717
Mailing Address - Fax:
Practice Address - Street 1:870 CORPORATE DR STE 301
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5419
Practice Address - Country:US
Practice Address - Phone:859-242-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2570641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0452Medicare ID - Type UnspecifiedMEDICARE