Individual
JOHN F. WILSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1135 SEVEN LAKES DRIVE, SUITE D, WEST END, NC 27376
(910) 638-4560
Mailing address
PO BOX 912, WEST END, NC 27376-0912
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2300
NC
103TA0400X
Addiction (Substance Use Disorder) Psychologist
2300
NC
103TB0200X
Cognitive & Behavioral Psychologist
2300
NC
103TC0700X
Clinical Psychologist
2300
NC
103TC1900X
Counseling Psychologist
2300
NC
103TC2200X
Clinical Child & Adolescent Psychologist
2300
NC
103TH0100X
Health Service Psychologist
2300
NC
103TM1800X
Intellectual & Developmental Disabilities Psychologist
2300
NC
103TP2701X
Group Psychotherapy Psychologist
2300
NC
103TR0400X
Rehabilitation Psychologist
2300
NC
103TS0200X
School Psychologist
2300
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13973
BCBS
NC
05
—
3403400
—
NC
01
—
562033116
TRICARETAX ID
NC
Enumeration date
04/06/2007
Last updated
03/17/2018
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