Individual
CHARLIE ISIAH WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
164 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526-8903
(843) 347-5060
(843) 347-3959
Mailing address
164 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526-8903
(843) 347-5060
(843) 347-3959
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
8742
SC
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
8742
SC
Other
Enumeration date
10/22/2018
Last updated
10/10/2024
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