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NPI Code Detail

MEDICARE: EBONY N WILSON MSW, LCSWA

MEDICARE: EBONY N WILSON MSW, LCSWA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerP022344NC

General Provider Information

NPI Number : 1073156063
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY N WILSON MSW, LCSWA
Provider Business Mailing Address
First Line : 10014 RED BLUFF CT
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-8381
Country : US
Telephone Number : 704-890-5562
Fax Number :
Provider Business Practice Location Address
First Line : 10130 MALLARD CREEK RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-6001
Country : US
Telephone Number : 980-382-2328
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2019
Last Update Date : 02/26/2026

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