Individual
LORI ANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3377 RIVERBEND DR, SPRINGFIELD, OR 97477-8803
(541) 222-8400
(541) 222-8401
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
(360) 729-1412
(360) 729-3025
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12-12-68
OR
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
A4541
OR
175T00000X
Peer Specialist
THW1524
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500679239
—
OR
Enumeration date
09/17/2014
Last updated
04/10/2019
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