Individual
MS. MARY WILSON WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPA-HSP
Contact information
Practice address
2532 GRAHAM ST, WINTERVILLE, NC 28590-8704
(252) 353-8487
Mailing address
2532 GRAHAM ST, WINTERVILLE, NC 28590-8704
(252) 353-8487
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1349
NC
Other
Enumeration date
10/06/2006
Last updated
07/26/2007
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