Provider Demographics
NPI:1548850829
Name:WILSON, NAQUIVIA (LCSWA)
Entity type:Individual
Prefix:
First Name:NAQUIVIA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 STONEDOWN LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-8034
Mailing Address - Country:US
Mailing Address - Phone:440-502-0890
Mailing Address - Fax:877-356-3296
Practice Address - Street 1:1501 N CHARLOTTE AVE STE B-127
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2525
Practice Address - Country:US
Practice Address - Phone:978-712-8110
Practice Address - Fax:877-356-3296
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NCP0177411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician