Provider Demographics
NPI:1457531519
Name:WILSON, STEVEN ALEXANDER (LPC, LCAS, NCC,)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ALEXANDER
Last Name:WILSON
Suffix:
Gender:M
Credentials:LPC, LCAS, NCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 W MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1588
Mailing Address - Country:US
Mailing Address - Phone:336-547-6361
Mailing Address - Fax:336-547-6364
Practice Address - Street 1:3719 W MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1588
Practice Address - Country:US
Practice Address - Phone:336-547-6361
Practice Address - Fax:336-547-6364
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5251101YP2500X
NC1601101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional