Individual
TINA ANDREA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAS-A
Contact information
Practice address
8430 UNIVERSITY EXEC PARK DR, STE. 655, CHARLOTTE, NC 28262-1350
(704) 596-5553
(704) 596-1556
Mailing address
8430 UNIVERSITY EXEC PARK DR, STE. 655, CHARLOTTE, NC 28262-1350
(704) 596-5553
(704) 596-1556
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3496A
NC
Other
Enumeration date
09/25/2013
Last updated
09/25/2013
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