Organization
CREECH ROAD SUPERVISED GARE
Active
Other names
Ezekiel Wilson
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EZEKIEL WILSON JR. (OWNER)
(919) 961-1392
Entity
Organization
Contact information
Practice address
311 NEW BERN AVE, # 27991, RALEIGH, NC 27611-0801
(919) 961-1392
Mailing address
808 CREECH RD, GARNER, NC 27529-2916
(919) 961-1392
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHL 092761
NC
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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