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General NPI Number Information
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NPI Number | 1821621749
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Entity Type | Organization
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Legal Business Name | KIM WILSON, MSW, LCSW, PLLC
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 3447 ROBINHOOD RD
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City | WINSTON SALEM
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State | NC
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Zip | 27106-4701
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Country | US
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Telephone | 419-450-2033
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Fax |
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Provider Business Mailing Address
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Address Line | 655 N SPRING ST
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City | WINSTON SALEM
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State | NC
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Zip | 27101-1326
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Country | US
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Telephone | 419-450-2033
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | KIM WILSON
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Credential | MSW, LCSW
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Telephone | 419-450-2033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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