| Doctor Name: | MR. ANDREW WILSON |
| NPI Number: | 1043688716 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 8660 |
| Business Practice Address: | 6007 Financial Plz Ste 213 Shreveport, LA - 711292638 |
| Business Phone Number: | 3184585158 |
| Business Fax Number: | 3182208108 |
| Mailing Address: | 9817 Hadrians Way, SHREVEPORT |
| State: | LA |
| Postal Code: | 711184843 |
| Phone Number: | 3184585158 |
| Fax Number: | 3182208108 |
| NPI Enumeration Date: | 09/11/2015 |
| NPI Last Update Date: | 09/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 8660 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |