Provider Demographics
NPI:1578733382
Name:WYLIE, JAMES M (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:WYLIE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4106
Mailing Address - Country:US
Mailing Address - Phone:704-864-7704
Mailing Address - Fax:704-862-0239
Practice Address - Street 1:214 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4106
Practice Address - Country:US
Practice Address - Phone:704-864-7704
Practice Address - Fax:704-862-0239
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional