Individual
ANTIGONE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCASA
Contact information
Practice address
2505 COURT DR, GASTONIA, NC 28054-2140
(704) 884-2060
(704) 854-4860
Mailing address
2505 COURT DR, GASTONIA, NC 28054-2140
(704) 884-2060
(704) 854-4860
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21258
NC
251S00000X
Community/Behavioral Health Agency
LCASA21258
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCASA21258
NORTH CAROLINA SUBSTANCE ABUSE BOARD
NC
Enumeration date
03/23/2016
Last updated
04/05/2016
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