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General NPI Number Information
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NPI Number | 1790218915
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Entity Type | Individual
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Provider Name | HEATHER WILSON MSW
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Gender | Female
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 3000 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1231
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Country | US
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Telephone | 919-350-8898
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Fax |
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Provider Business Mailing Address
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Address Line | 1416 MORING ST
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City | RALEIGH
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State | NC
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Zip | 27603-2350
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Country | US
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Telephone | 443-812-0306
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 22040
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C012252
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License Number State | NC
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