Provider Demographics
NPI:1689316945
Name:WILSON, DONNA COLLINS
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:COLLINS
Last Name:WILSON
Suffix:
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 1:1254 PINE TOP RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-6265
Mailing Address - Country:US
Mailing Address - Phone:336-423-1391
Mailing Address - Fax:
Practice Address - Street 1:1504 JAKE ALEXANDER BLVD W
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1213
Practice Address - Country:US
Practice Address - Phone:704-645-8539
Practice Address - Fax:704-645-9003
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC165699163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)