Provider Demographics
NPI:1164313284
Name:WILSON, GRACE (DACM, MAOM, LAC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:DACM, MAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 PINNACLE PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9228
Mailing Address - Country:US
Mailing Address - Phone:828-545-0512
Mailing Address - Fax:
Practice Address - Street 1:247 CHARLOTTE ST # R3
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1466
Practice Address - Country:US
Practice Address - Phone:804-239-7362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2155171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist