Provider Demographics
NPI:1780860692
Name:WILSON, KENNETH JAMES (LPC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JAMES
Last Name:WILSON
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 1:512 SANDY WHISPERS PL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-0873
Mailing Address - Country:US
Mailing Address - Phone:919-251-9420
Mailing Address - Fax:
Practice Address - Street 1:1323 WATTS ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1134
Practice Address - Country:US
Practice Address - Phone:919-667-9988
Practice Address - Fax:919-667-9944
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health