NPIMap

Individual provider Active NPI

Demetrice Wilson, LCAS-A

  • Mental Health Counselor
  • Williamston, NC
National Provider Identifier
1700120409
Registry record updated Nov 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
2888-A Issued in NC
Practice address
132 W Main St
Williamston, NC 27892-2472
Phone
(252) 792-7812
Fax
(252) 792-7812
NPI assigned
Nov 19, 2012
Last updated
Nov 19, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 2888-A NC Primary

Addresses

Primary practice location

132 W Main St
Williamston, NC 27892-2472

Mailing address

132 W Main St
Williamston, NC 27892-2472
Phone (252) 792-7812

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

LicenseStateTypeSpecialty
2888-ANCMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Elite Care Inc Past Accepting new patients
Elite Care Inc Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353283200000",
    "number": "1700120409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 W MAIN ST",
            "city": "WILLIAMSTON",
            "state": "NC",
            "postal_code": "278922472",
            "telephone_number": "252-792-7812",
            "fax_number": "252-792-7812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 W MAIN ST",
            "city": "WILLIAMSTON",
            "state": "NC",
            "postal_code": "278922472",
            "telephone_number": "252-792-7812",
            "fax_number": "252-792-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DEMETRICE",
        "credential": "LCAS-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-19",
        "last_updated": "2012-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "2888-A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamston, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.