Provider Demographics
NPI:1073860326
Name:WILSON, BRITTANI E (LCSW)
Entity type:Individual
Prefix:
First Name:BRITTANI
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRITTANI
Other - Middle Name:
Other - Last Name:TESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1907
Mailing Address - Fax:
Practice Address - Street 1:3437 US HIGHWAY 601 N
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-6259
Practice Address - Country:US
Practice Address - Phone:336-492-5421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2080C0008X
NCC0100821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics