Doctor Name: | MR. ROBERT J WILSON |
NPI Number: | 1205804838 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPCS |
License Number: | 3415 |
Business Practice Address: | 360 Beech St Newland, NC - 286579670 |
Business Phone Number: | 8287335889 |
Business Fax Number: | 8287338743 |
Mailing Address: | 284 Executive Park Dr Ste 100, CONCORD |
State: | NC |
Postal Code: | 280251833 |
Phone Number: | 7049391100 |
Fax Number: | 7049391173 |
NPI Enumeration Date: | 03/09/2006 |
NPI Last Update Date: | 07/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3415 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |