Individual
MR. JOHNNIE LEFUEL WILSON IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCASA
Contact information
Practice address
6307 MELODY LN, FAYETTEVILLE, NC 28304-5554
(910) 627-7210
Mailing address
6307 MELODY LN, FAYETTEVILLE, NC 28304-5554
(910) 627-7210
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
A25300
NC
Other
Enumeration date
03/11/2019
Last updated
03/11/2019
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