Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 8723E-I | AR |
N | 103TA0700X | Adult Development & Aging Psychologist | 8723E-I | AR |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 8723E-I | AR |
Y | 103G00000X | Clinical Psychologist | 8723E-I | AR |
Y | 103TC0700X | Clinical Psychologist | 8723E-I | AR |
N | 103TC1900X | Counseling Psychologist | 8723E-I | AR |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 8723E-I | AR |
N | 103TF0000X | Family Psychologist | 8723E-I | AR |
N | 103TM1800X | Intellectual & Developmental Disabilities | 8723E-I | AR |
N | 103TP0814X | Psychoanalysis | 8723E-I | AR |
N | 103TP2701X | Group Psychotherapist | 8723E-I | AR |
N | 103TR0400X | Rehabilitation Psychologist | 8723E-I | AR |
N | 103TS0200X | School Psychologist | 8723E-I | AR |
N | 104100000X | Social Worker | 8723E-I | AR |
NPI | 1275802357 |
---|---|
Provider Name | Donald Wilson SR. |
First Address | Searcy, AR 72143-4802 |
Second Address | Searcy, AR 72143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2011 |
Last Update Date | 06/07/2015 |