Individual
MRS. CAROL DEW WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA,LCSW
Contact information
Practice address
1758 POTOMAC DR, FAYETTEVILLE, NC 28304-3725
(910) 824-4395
Mailing address
1758 POTOMAC DR, FAYETTEVILLE, NC 28304-3725
(910) 824-4395
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C002036
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13850
BLUE CROSS BLUE SHIELD NC
NC
Enumeration date
04/28/2010
Last updated
04/28/2010
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