Provider Demographics
NPI:1588059109
Name:WILEY, PATRICIA (LPCA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 LAKESIDE LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-0618
Mailing Address - Country:US
Mailing Address - Phone:254-702-6576
Mailing Address - Fax:
Practice Address - Street 1:432 LAKESIDE LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-0618
Practice Address - Country:US
Practice Address - Phone:254-702-6576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health