Provider Demographics
NPI:1982331328
Name:WILSON, MATTHEW (LCMHC/A)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:LCMHC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 BAILEYWICK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1977
Mailing Address - Country:US
Mailing Address - Phone:919-845-5400
Mailing Address - Fax:919-845-5431
Practice Address - Street 1:9205 BAILEYWICK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1977
Practice Address - Country:US
Practice Address - Phone:919-845-5400
Practice Address - Fax:919-845-5431
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17833101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor