Individual
CEDRIC WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3959 ELECTRIC RD STE 330, ROANOKE, VA 24018-4563
(540) 339-7674
(540) 685-0994
Mailing address
2907 OAK CREST AVE SW, ROANOKE, VA 24015-4609
(540) 339-7674
(540) 685-0994
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701008867
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
0701008867
VA
101YM0800X
Mental Health Counselor
Primary
0701008867
VA
101YP2500X
Professional Counselor
0701008867
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013502137
NPI2
VA
Enumeration date
06/23/2020
Last updated
10/05/2023
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