Provider Demographics
NPI:1073673299
Name:WILSON, JANE FRANCES (LMFT, LPC, LCAS)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:FRANCES
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT, LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3624
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-3624
Mailing Address - Country:US
Mailing Address - Phone:828-439-8191
Mailing Address - Fax:828-439-2622
Practice Address - Street 1:207 QUEEN ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3341
Practice Address - Country:US
Practice Address - Phone:828-439-8191
Practice Address - Fax:828-439-2622
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3467101YM0800X
102L00000X
NC720106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC610575Medicaid
NC132Y2OtherBCBS