Active NPI
Ifeanyi C Willson, LCSW
- Clinical Social Worker
- Apache Junction, AZ
National Provider Identifier
1801290051
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-15631
- Practice address
- 183 W Apache TRL Ste B109
Apache Junction, AZ 85120-3425 - Phone
- (480) 618-0945
- NPI assigned
- Oct 17, 2014
- Last updated
- Apr 13, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-15631 | AZ | Primary |
Addresses
Primary practice location
183 W Apache TRL Ste B109
Apache Junction, AZ 85120-3425
Mailing address
PO Box 746093
Atlanta, GA 30374-6093
Other practice location 1
2120 S McClintock Dr
Suite 105
Tempe, AZ 85282-2692
Phone (480) 804-0326
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind Provider Network LLC | Clinical | Current | Accepting new patients |
Locations
20 E Thomas Rd
Ste 2200
Phoenix, AZ 85012
Phone (310) 515-8113
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681344000000",
"number": "1801290051",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 746093",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303746093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "183 W APACHE TRL STE B109",
"city": "APACHE JUNCTION",
"state": "AZ",
"postal_code": "851203425",
"telephone_number": "480-618-0945"
}
],
"practiceLocations": [
{
"address_1": "2120 S McClintock Dr",
"address_2": "Suite 105",
"address_purpose": "LOCATION",
"city": "Tempe",
"state": "AZ",
"postal_code": "852822692",
"country_code": "US",
"telephone_number": "480-804-0326",
"fax_number": "480-302-7884",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILLSON",
"first_name": "IFEANYI",
"middle_name": "C",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-17",
"last_updated": "2023-04-13",
"certification_date": "2023-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "LCSW-15631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Apache Junction, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.