Organization
KIM WILSON, MSW, LCSW, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM WILSON MSW, LCSW (LCSW)
(419) 450-2033
Entity
Organization
Contact information
Practice address
3447 ROBINHOOD RD, WINSTON SALEM, NC 27106-4701
(419) 450-2033
Mailing address
655 N SPRING ST, WINSTON SALEM, NC 27101-1326
(419) 450-2033
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508341876
NPI
—
Enumeration date
02/19/2020
Last updated
02/19/2020
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