Carmen Marie Wilson

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

302876 Issued in MN

Practice address

725 Center Ave
Moorhead, MN 56560-1958

Phone

(507) 720-7775

Fax

(218) 287-1267

NPI assigned

Feb 23, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Tomorrow, LLC

  dba Starboard

  • Substance Abuse Rehabilitation Facility
  • Moorhead, MN
  • NPI 1942846555
  NPD Authorized official
• Tomorrow, LLC

  • Addiction (Substance Use Disorder) Counselor
  • Moorhead, MN
  • NPI 1245573435
  NPD (past) Authorized official
• Tomorrow, LLC

  dba South Rock

  • Mental Illness Community Based Residential Treatment Facility
  • Litchfield, MN
  • NPI 1689965675
  Authorized official Same address or phone
• Tomorrow, LLC

  dba South Rock

  • Mental Illness Community Based Residential Treatment Facility
  • Litchfield, MN
  • NPI 1932312055
  Authorized official Same address or phone

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

{
    "created_epoch": "1614038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1740874536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "city": "PILLAGER",
            "state": "MN",
            "postal_code": "564730128",
            "telephone_number": "507-720-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 CENTER AVE",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565601958",
            "telephone_number": "507-720-7775",
            "fax_number": "218-287-1267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CARMEN",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-23",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "2467908",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN DHS",
            "identifier": "1444799",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "wendyw.anchorage@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Director",
            "address_1": "725 Center Ave",
            "city": "Moorhead",
            "state": "MN",
            "country_code": "US",
            "postal_code": "565601958",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "cferris.anchorage@gmail.com",
            "affiliation": "N",
            "endpointDescription": "owner's  associate business email",
            "address_1": "725 Center Ave",
            "city": "Moorhead",
            "state": "MN",
            "country_code": "US",
            "postal_code": "565601958",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "carmenmw@brainerd.net",
            "affiliation": "N",
            "endpointDescription": "business email",
            "address_1": "11680 County Road 1 SW",
            "city": "Pillager",
            "state": "MN",
            "country_code": "US",
            "postal_code": "564732449",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rollin Elis Wiger, RPH
• Maggie Wilken, MSW,LICSW
• Sara Williams
• Patrick Alexander Williamson, O.D.
• Kaila Beth Wilner, PHARM D
• Hope Wilson
• Jessie Wilson
• Michelle Wilson, M.ED. LPCC, LADC
• Shaina E Winning
• Wise Wellness Center LLC

• Addiction (Substance Use Disorder) Counselor in Moorhead, MN
• Providers in Moorhead, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; 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.