Provider Demographics
NPI:1285456004
Name:THE WILSON HOUSE GROUP LLC
Entity type:Organization
Organization Name:THE WILSON HOUSE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-491-5871
Mailing Address - Street 1:1711 W LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1130
Mailing Address - Country:US
Mailing Address - Phone:919-491-5871
Mailing Address - Fax:919-381-9760
Practice Address - Street 1:2524 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1463
Practice Address - Country:US
Practice Address - Phone:919-491-5871
Practice Address - Fax:919-381-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health