Healthcare Provider Details

I. General information

NPI: 1457531519
Provider Name (Legal Business Name): STEVEN ALEXANDER WILSON LPC, LCAS, NCC,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 W MARKET ST SUITE B
GREENSBORO NC
27403-1588
US

IV. Provider business mailing address

3719 W MARKET ST SUITE B
GREENSBORO NC
27403-1588
US

V. Phone/Fax

Practice location:
  • Phone: 336-547-6361
  • Fax: 336-547-6364
Mailing address:
  • Phone: 336-547-6361
  • Fax: 336-547-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1601
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5251
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: