Provider Demographics
NPI:1821142506
Name:WILSON, PAULA F (BA, CAC-P)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:F
Last Name:WILSON
Suffix:
Gender:F
Credentials:BA, CAC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1252
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-1252
Mailing Address - Country:US
Mailing Address - Phone:864-707-2817
Mailing Address - Fax:864-564-4117
Practice Address - Street 1:335 CAULDER AVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306
Practice Address - Country:US
Practice Address - Phone:864-541-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD10SPMedicaid