Healthcare Provider Details

I. General information

NPI: 1508295429
Provider Name (Legal Business Name): ALEXANDER WILSON LPC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 WEST MARKET STREET SUITE B
GREENSBORO NC
27403
US

IV. Provider business mailing address

PO BOX 782
OAK RIDGE NC
27310-0782
US

V. Phone/Fax

Practice location:
  • Phone: 336-547-6362
  • 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: STEVEN ALEXANDER WILSON
Title or Position: PRESIDENT/OWNER
Credential: LCAS, LPC
Phone: 336-706-2387