Provider Demographics
NPI:1366591869
Name:WILSON, HOLLY (NCC, LPC)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 N ROAD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3335
Mailing Address - Country:US
Mailing Address - Phone:252-333-5519
Mailing Address - Fax:252-335-5365
Practice Address - Street 1:1241 N ROAD ST
Practice Address - Street 2:SUITE A
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3335
Practice Address - Country:US
Practice Address - Phone:252-333-5519
Practice Address - Fax:252-335-5365
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional