Provider Demographics
NPI:1326579806
Name:WILSON, XAVIOUS (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:XAVIOUS
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
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 1:5960 FAIRVIEW RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3119
Mailing Address - Country:US
Mailing Address - Phone:833-356-6732
Mailing Address - Fax:
Practice Address - Street 1:8401 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 106
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3386
Practice Address - Country:US
Practice Address - Phone:704-716-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-25
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069561041C0700X
NCC0131861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical