Individual
WILKIAM WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1290 HALSTEAD BLVD, ELIZABETH CITY, NC 27909
(252) 333-8445
Mailing address
PO BOX 1614, ELIZABETH CITY, NC 27906-1614
(252) 312-0516
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-21440
NC
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
07/25/2014
Last updated
01/08/2021
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