Provider Demographics
NPI:1821599820
Name:WILSON, RENEE BERNICE (MA, LCMHC, NCC, LCAS)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:BERNICE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LCMHC, NCC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 WESTWOOD SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1532
Mailing Address - Country:US
Mailing Address - Phone:910-964-0075
Mailing Address - Fax:910-335-8034
Practice Address - Street 1:3274 ROSEHILL RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-964-0075
Practice Address - Fax:910-335-8034
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-24
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23882101YA0400X
NC13489101YP2500X
NCA-13489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)