Healthcare Provider Details

I. General information

NPI: 1578733382
Provider Name (Legal Business Name): JAMES M WYLIE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E FRANKLIN BLVD
GASTONIA NC
28052-4106
US

IV. Provider business mailing address

214 E FRANKLIN BLVD
GASTONIA NC
28052-4106
US

V. Phone/Fax

Practice location:
  • Phone: 704-864-7704
  • Fax: 704-862-0239
Mailing address:
  • Phone: 704-864-7704
  • Fax: 704-862-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3726
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: