Provider Demographics
NPI:1912317249
Name:WILSON, BARBARA FAULK (LPCA)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:FAULK
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PINEHURST MNR APT A
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8212
Mailing Address - Country:US
Mailing Address - Phone:910-783-9590
Mailing Address - Fax:910-295-9175
Practice Address - Street 1:230 W PENNSYLVANIA AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5431
Practice Address - Country:US
Practice Address - Phone:910-783-9590
Practice Address - Fax:910-295-9175
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA10633OtherNCBLPC
NCPENDINGMedicaid