Provider Demographics
NPI:1669093548
Name:WILEY, NETASHIA MICHELLE (LCSWA)
Entity type:Individual
Prefix:
First Name:NETASHIA
Middle Name:MICHELLE
Last Name:WILEY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MINERAL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27311-9787
Mailing Address - Country:US
Mailing Address - Phone:336-280-8425
Mailing Address - Fax:
Practice Address - Street 1:5270 UNION RIDGE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-7594
Practice Address - Country:US
Practice Address - Phone:336-421-3247
Practice Address - Fax:336-421-3275
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0143271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical