Provider Demographics
NPI:1841303120
Name:HAAS, WILMER EUGENE (LPA)
Entity type:Individual
Prefix:MR
First Name:WILMER
Middle Name:EUGENE
Last Name:HAAS
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:MR
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPA
Mailing Address - Street 1:170 DAVIDSON HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4245
Mailing Address - Country:US
Mailing Address - Phone:704-795-3060
Mailing Address - Fax:704-784-9316
Practice Address - Street 1:170 DAVIDSON HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4245
Practice Address - Country:US
Practice Address - Phone:704-795-3060
Practice Address - Fax:704-784-9316
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC-1512103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135W1OtherBCBS PROVIDER OF NC
NC6107151Medicaid