Individual
TYHESSA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCASA
Contact information
Practice address
511 MARTIN LUTHER KING JR DR, LUMBERTON, NC 28358-5443
(910) 370-0018
(919) 820-8551
Mailing address
511 MARTIN LUTHER KING JR DR, LUMBERTON, NC 28358-5443
(910) 370-0018
(919) 820-8551
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
27039
NC
Other
Enumeration date
04/11/2024
Last updated
04/11/2024
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