Active NPI
Tina Wilson
- Mental Illness Community Based Residential Treatment Facility
- Mt Holly, NC
National Provider Identifier
1033653720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- License
- MHL-036-323
- Practice address
- 139 Whippoorwill LN
Mt Holly, NC 28120-9761 - Phone
- (704) 574-1549
- NPI assigned
- Dec 14, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | MHL-036-323 | NC | Primary |
Addresses
Primary practice location
139 Whippoorwill LN
Mt Holly, NC 28120-9761
Mailing address
205 Whippoorwill LN
Mt Holly, NC 28120-9761
Phone (704) 574-1549
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MHL-036-323 | NC | MD | Mental Illness Community Based Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502323200000",
"number": "1033653720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 WHIPPOORWILL LN",
"city": "MT HOLLY",
"state": "NC",
"postal_code": "281209761",
"telephone_number": "704-574-1549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "139 WHIPPOORWILL LN",
"city": "MT HOLLY",
"state": "NC",
"postal_code": "281209761",
"telephone_number": "704-574-1549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "TINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-12-14",
"last_updated": "2017-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "NC",
"license": "MHL-036-323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt Holly, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.