| Doctor Name: | MRS. SANDRA J WILSON |
| NPI Number: | 1316906415 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | 73-9-E |
| Business Practice Address: | 304 W Collin Raye Dr 103-a De Queen, AR - 718322013 |
| Business Phone Number: | 8705184140 |
| Business Fax Number: | 9033857105 |
| Mailing Address: | 304 W Collin Raye Dr, 103-a DE QUEEN |
| State: | AR |
| Postal Code: | 718322013 |
| Phone Number: | 8705184140 |
| Fax Number: | 9033857105 |
| NPI Enumeration Date: | 03/20/2006 |
| NPI Last Update Date: | 02/21/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 73-9-E |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |