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General NPI Number Information
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NPI Number | 1508295429
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Entity Type | Organization
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Legal Business Name | ALEXANDER WILSON LPC INC
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 3719 WEST MARKET STREET SUITE B
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City | GREENSBORO
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State | NC
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Zip | 27403
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Country | US
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Telephone | 336-547-6362
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Fax | 336-547-6364
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Provider Business Mailing Address
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Address Line | PO BOX 782
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City | OAK RIDGE
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State | NC
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Zip | 27310-0782
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Country | US
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Telephone | 336-547-6361
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Fax | 336-547-6364
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | STEVEN ALEXANDER WILSON
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Credential | LCAS, LPC
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Telephone | 336-706-2387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5251
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1601
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License Number State | NC
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