Provider Demographics
NPI:1184611832
Name:WILSON, TERRY M (LCSW)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9008
Mailing Address - Country:US
Mailing Address - Phone:919-580-0334
Mailing Address - Fax:
Practice Address - Street 1:211 FOREST CIR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-9008
Practice Address - Country:US
Practice Address - Phone:919-580-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-28
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1041C0700X
NCC0060061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical