Provider Demographics
NPI:1629596994
Name:WILSON, MEREDITH GARRISON (LCMHC)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:GARRISON
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 LAKE GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6986
Mailing Address - Country:US
Mailing Address - Phone:704-860-8440
Mailing Address - Fax:
Practice Address - Street 1:1517 SPENCER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3016
Practice Address - Country:US
Practice Address - Phone:704-860-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13329101YM0800X, 101YP2500X
NC13329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health