Doris Gardner-Wilson, LCSW, LCDC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

58672 Issued in TX

Practice address

14825 Saint Marys LN Ste 122
Houston, TX 77079-2989

Phone

(832) 489-1998

NPI assigned

Dec 16, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Doris Gardner Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shine Medical Providers PC

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1538894050
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1316368434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6539 HOLLOW OAKS DR STE F",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770503717",
            "telephone_number": "823-489-1998",
            "fax_number": "713-589-4730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14825 SAINT MARYS LN STE 122",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770792989",
            "telephone_number": "832-489-1998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER-WILSON",
        "first_name": "DORIS",
        "credential": "LCSW, LCDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-16",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "9650",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TX",
            "license": "58672",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "58672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS DRIVERS LICENSE",
            "identifier": "13255920",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DORIS",
            "last_name": "GARDNER",
            "credential": "LCSW, LCDC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carolyn L Gardiner, M.D.
• Helena M Gardiner, M.D.
• Taylor Gardiner, PA
• Gardner House
• Beverly Ann Gardner-Nelson, LMSW-AP, LCDC, CCJP
• Alison E. Gardner, PHD, RN, CNS
• Amber L Gardner, FNP
• Amity L Gardner, DDS
• Calida Latonia Gardner, CNM
• Carly S Gardner, MD

• Clinical Social Worker in Houston, TX
• Providers in Houston, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.