Provider Demographics
NPI:1750179222
Name:WILSON, CURTIS TODD
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:TODD
Last Name:WILSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PARK CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-1711
Mailing Address - Country:US
Mailing Address - Phone:304-400-5599
Mailing Address - Fax:
Practice Address - Street 1:15043 MACCORKLE AVE # 309
Practice Address - Street 2:
Practice Address - City:CABIN CREEK
Practice Address - State:WV
Practice Address - Zip Code:25035-4000
Practice Address - Country:US
Practice Address - Phone:681-265-5090
Practice Address - Fax:681-265-5090
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist