Provider Demographics
NPI:1700103215
Name:WILSON, DUNCAN SCOTT
Entity type:Individual
Prefix:MR
First Name:DUNCAN
Middle Name:SCOTT
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 ERWIN RD
Mailing Address - Street 2:SUITE 148, BOX 268
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4596
Mailing Address - Country:US
Mailing Address - Phone:919-491-4640
Mailing Address - Fax:
Practice Address - Street 1:2608 ERWIN RD
Practice Address - Street 2:SUITE 148, BOX 268
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4596
Practice Address - Country:US
Practice Address - Phone:919-491-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health