Individual
MRS. TENNILLE KRISTINE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCA
Contact information
Practice address
6415 CAMDEN RD STE 109, FAYETTEVILLE, NC 28306-7584
(910) 670-5241
Mailing address
6880 BLAKE RD, STEDMAN, NC 28391-8667
(910) 670-5241
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
A14226
NC
Other
Enumeration date
07/08/2019
Last updated
07/08/2019
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