Provider Demographics
NPI:1861909517
Name:EASTERWOOD-WILSON, APRIL LEIGH
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:LEIGH
Last Name:EASTERWOOD-WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 VANTAGE POINTE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-4068
Mailing Address - Country:US
Mailing Address - Phone:615-574-4654
Mailing Address - Fax:
Practice Address - Street 1:1321 VANTAGE POINTE
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-4068
Practice Address - Country:US
Practice Address - Phone:615-574-4654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1-17-28859OtherBCBA
TN1-17-28859Medicaid