Provider Demographics
NPI:1932088820
Name:WILSON, PHILLIP EDWARD (LCSW-A)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:EDWARD
Last Name:WILSON
Suffix:
Gender:M
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24332
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-4332
Mailing Address - Country:US
Mailing Address - Phone:980-333-2272
Mailing Address - Fax:980-333-2272
Practice Address - Street 1:963 KIRKPATRICK RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8911
Practice Address - Country:US
Practice Address - Phone:336-421-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0226251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical