Provider Demographics
NPI:1073389433
Name:WILSON, JOSSLYN
Entity Type:Individual
Prefix:
First Name:JOSSLYN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOSSLYN
Other - Middle Name:
Other - Last Name:WILSON-PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:375 SE BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-6057
Mailing Address - Country:US
Mailing Address - Phone:910-725-0702
Mailing Address - Fax:
Practice Address - Street 1:375 SE BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6057
Practice Address - Country:US
Practice Address - Phone:910-725-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician