Provider Demographics
NPI:1588713069
Name:WILEY, DAVID A (MS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:WILEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 PIRATE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2862
Mailing Address - Country:US
Mailing Address - Phone:919-846-9259
Mailing Address - Fax:
Practice Address - Street 1:1500 SUNDAY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5151
Practice Address - Country:US
Practice Address - Phone:919-854-5454
Practice Address - Fax:919-854-4343
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2457101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional