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General NPI Number Information
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NPI Number | 1083569149
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Entity Type | Organization
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Legal Business Name | WILSON PROFESSIONAL SERVICES TREATMENT CENTER
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 2503 N QUEEN ST
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City | KINSTON
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State | NC
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Zip | 28501-1632
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Country | US
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Telephone | 208-283-7792
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 SPRING VALLEY ROAD SUITE 600 EAST
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City | DALLAS
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State | TX
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Zip | 75244
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Country | US
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Telephone | 208-283-7792
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANTHONY KILGORE
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Credential |
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Telephone | 208-283-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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