Individual
KELLY KENDRA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3162 W MARTIN LUTHER KING BLVD STE 13-14, FAYETTEVILLE, AR 72704-7679
(479) 935-4834
Mailing address
614 E EMMA AVE STE 300, SPRINGDALE, AR 72764-4469
(479) 751-7417
(479) 751-4898
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8293-C
AR
1041C0700X
Clinical Social Worker
8293-M
AR
Other
Enumeration date
02/16/2017
Last updated
06/08/2020
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