Provider Demographics
NPI:1114302320
Name:CLAY WILSON AND ASSOCIATES, INC
Entity Type:Organization
Organization Name:CLAY WILSON AND ASSOCIATES, INC
Other - Org Name:THE COGNITIVE CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:828-327-6026
Mailing Address - Street 1:1109 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-2545
Mailing Address - Country:US
Mailing Address - Phone:828-327-6026
Mailing Address - Fax:828-327-8096
Practice Address - Street 1:1109 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-2545
Practice Address - Country:US
Practice Address - Phone:828-327-6026
Practice Address - Fax:828-327-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0092121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP009212OtherLCSW-A LICENSURE