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General NPI Number Information
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NPI Number | 1750179222
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Entity Type | Individual
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Provider Name | CURTIS TODD WILSON
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Gender | Male
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 15043 MACCORKLE AVE # 309
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City | CABIN CREEK
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State | WV
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Zip | 25035-4000
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Country | US
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Telephone | 681-265-5090
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Fax | 681-265-5090
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Provider Business Mailing Address
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Address Line | 3 PARK CT
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City | CHARLESTON
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State | WV
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Zip | 25302-1711
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Country | US
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Telephone | 304-400-5599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | WV
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