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General NPI Number Information
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NPI Number | 1881405702
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Entity Type | Individual
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Provider Name | MARISSA JEANNE WILSON MSW, LCSWA
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 5 OAK BRANCH DR STE H
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City | GREENSBORO
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State | NC
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Zip | 27407-2157
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Country | US
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Telephone | 336-288-9190
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Fax | 336-450-4318
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Provider Business Mailing Address
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Address Line | 1837 NEELLEY RD
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City | PLEASANT GARDEN
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State | NC
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Zip | 27313-9227
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Country | US
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Telephone | 336-479-3301
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P021684
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License Number State | NC
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