Provider Demographics
NPI:1891816633
Name:WILEMON, DANIEL H (LPC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:WILEMON
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 1:2200 SILAS CREEK PKWY
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5000
Mailing Address - Country:US
Mailing Address - Phone:336-722-7300
Mailing Address - Fax:336-722-7311
Practice Address - Street 1:2200 SILAS CREEK PKWY
Practice Address - Street 2:SUITE 1-A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5000
Practice Address - Country:US
Practice Address - Phone:336-722-7300
Practice Address - Fax:336-722-7311
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0294KOtherBCBSNC GROUP
NC890294KMedicaid
NC1581Medicare ID - Type UnspecifiedGROUP MEDICARE