Organization
ABC PLAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILKIAM WILSON BS, MS, ITFS, LCAS-A (IFTS, LCAS-A)
(252) 312-0516
Entity
Organization
Contact information
Practice address
1290 HALSTEAD BLVD, ELIZABETH CITY, NC 27909-5840
(252) 333-8445
(252) 404-9136
Mailing address
PO BOX 1614, ELIZABETH CITY, NC 27906-1614
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
NC
Other
Enumeration date
02/10/2015
Last updated
01/08/2021
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