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Individual

TIFFANY DANIELLE WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP-BC

Contact information

Practice address
925 BRADLEY ST, CONCORD, NC 28025-0911
(704) 360-3637
Mailing address
1218 LAUREL WOODS DR, GASTONIA, NC 28052-5433
(704) 300-4706

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
286968
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5016128
NC

Other

Enumeration date
09/21/2021
Last updated
06/24/2024
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