Provider Demographics
NPI:1205804838
Name:WILSON, ROBERT J (LPCS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:WILSON
Suffix:
Gender:M
Credentials:LPCS
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Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:360 BEECH ST
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657-9670
Practice Address - Country:US
Practice Address - Phone:828-733-5889
Practice Address - Fax:828-733-8743
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC3415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102886Medicaid