Provider Demographics
NPI:1508575648
Name:WILSON, SARA ELIZABETH VII
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:VII
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 MAUNEY COVE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-6289
Mailing Address - Country:US
Mailing Address - Phone:757-879-1807
Mailing Address - Fax:
Practice Address - Street 1:1841 MAUNEY COVE RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-6289
Practice Address - Country:US
Practice Address - Phone:757-879-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician