Individual
KENDRA ANN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
PO BOX 123, IVY, VA 22945-0123
(757) 734-1300
Mailing address
PO BOX 123, IVY, VA 22945-0123
(757) 734-1300
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
12059
MD
1041C0700X
Clinical Social Worker
Primary
0904013071
VA
1041C0700X
Clinical Social Worker
C005785
NC
Other
Enumeration date
11/21/2006
Last updated
05/16/2024
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