Individual
ANNA MICHAELE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5570
Mailing address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5570
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2003020116
MO
1041C0700X
Clinical Social Worker
Primary
2003020116
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003020116
LCSW LICENSURE
MO
Enumeration date
07/08/2005
Last updated
04/11/2022
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