Provider Demographics
NPI:1811143696
Name:WILSON, CAMILLE M (NCC)
Entity type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 GLADWICK CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5256
Mailing Address - Country:US
Mailing Address - Phone:704-649-4886
Mailing Address - Fax:
Practice Address - Street 1:442 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8222
Practice Address - Country:US
Practice Address - Phone:704-980-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional