Provider Demographics
NPI:1295564508
Name:WILSON, ERICA (MED, LCMHCA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MED, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BEDFORD GRN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7332
Mailing Address - Country:US
Mailing Address - Phone:910-372-2992
Mailing Address - Fax:
Practice Address - Street 1:201 NEW BRIDGE ST STE 105
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4736
Practice Address - Country:US
Practice Address - Phone:910-336-4958
Practice Address - Fax:910-333-9742
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20238101YM0800X, 101YP2500X
NC1254996101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty