Provider Demographics
NPI:1952907701
Name:WILSON, MARK ADAM
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ADAM
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 OAKMONT CT
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-7234
Mailing Address - Country:US
Mailing Address - Phone:980-234-6503
Mailing Address - Fax:
Practice Address - Street 1:1034 OAKMONT CT
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-7234
Practice Address - Country:US
Practice Address - Phone:980-234-6503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical