Provider Demographics
NPI:1649405846
Name:WIMBERLY, SYLVIA JEAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:JEAN
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CURTIS ROAD
Mailing Address - Street 2:BLDG. 4546, SUITE 100
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110
Mailing Address - Country:US
Mailing Address - Phone:318-456-6595
Mailing Address - Fax:
Practice Address - Street 1:243 CURTIS ROAD
Practice Address - Street 2:BLDG. 4546, SUITE 100
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110
Practice Address - Country:US
Practice Address - Phone:318-456-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA26031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical