MEDICARE: MRS. ROXANNE ANNESA WILSON-MILLER LCSW

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
1	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	C019948	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C019948	OTHER	NC	SOCIAL WORK BOARD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669858858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROXANNE ANNESA WILSON-MILLER LCSW

Provider Business Mailing Address
First Line	:	3057 FREEDOM DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3859
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3057 FREEDOM DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3859
Country	:	US
Telephone Number	:	743-253-7042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	04/27/2026

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