Provider Demographics
NPI:1669852224
Name:WILSON, BOYD III (MSW, LCSWA, LCAS)
Entity Type:Individual
Prefix:
First Name:BOYD
Middle Name:
Last Name:WILSON
Suffix:III
Gender:M
Credentials:MSW, LCSWA, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11226 SLIDER DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6406
Mailing Address - Country:US
Mailing Address - Phone:919-801-5818
Mailing Address - Fax:
Practice Address - Street 1:106 RIDGE VIEW DR STE D
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6647
Practice Address - Country:US
Practice Address - Phone:919-801-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20049101YA0400X
NCP0080671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)