Provider Demographics
NPI:1124123484
Name:WILSON, DEANNA M (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 ROGERS RD
Mailing Address - Street 2:#236
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9306
Mailing Address - Country:US
Mailing Address - Phone:919-395-7110
Mailing Address - Fax:
Practice Address - Street 1:853 WAKE FOREST BUSINESS PARK STE D
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6519
Practice Address - Country:US
Practice Address - Phone:919-395-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0056791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007315Medicaid