Individual
MS. LISA RENEE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2091 NE 35TH ST, OCALA, FL 34479-2909
(352) 732-1355
Mailing address
PO BOX 685, CITRA, FL 32113
(352) 425-8454
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW 10251
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
766681100
—
FL
Enumeration date
04/27/2007
Last updated
04/11/2013
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