Provider Demographics
NPI:1134401417
Name:LINDA S. WILSON, PHD, PLLC
Entity type:Organization
Organization Name:LINDA S. WILSON, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-215-0589
Mailing Address - Street 1:1011 TUNNEL RD STE 240
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-2060
Mailing Address - Country:US
Mailing Address - Phone:828-215-0589
Mailing Address - Fax:828-412-0282
Practice Address - Street 1:1011 TUNNEL RD STE 240
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2060
Practice Address - Country:US
Practice Address - Phone:828-215-0589
Practice Address - Fax:828-412-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2722103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001079Medicaid
NC50880OtherHEALTH SERVICES PROVIDER - PSYCHOLOGIST
NC6001079Medicaid