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KIMBERLY LANNETTE WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMFT

Contact information

Practice address
2015 AYRSLEY TOWN BLVD, SUITE 202, CHARLOTTE, NC 28273-4067
(704) 280-8502
(800) 858-2194
Mailing address
15105D JOHN J DELANEY DR STE 192, CHARLOTTE, NC 28277-2741
(704) 769-0660
(800) 858-2194

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1303
NC
106H00000X
Marriage & Family Therapist
4101006188
MI
106H00000X
Marriage & Family Therapist
785
TN
106H00000X
Marriage & Family Therapist
MFT000954
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
090073276A
GA
Enumeration date
01/25/2007
Last updated
12/11/2020
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