Individual
COURTNEY PAIGE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
149.021778
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149.021778
IDFPR
IL
Enumeration date
01/25/2018
Last updated
11/15/2019
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