Active NPI
Acacia Wilson
- Clinical Social Worker
- Charlotte, NC
National Provider Identifier
1811638562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P015235
- Practice address
- 10150 Mallard Creek Rd Ste 104
Charlotte, NC 28262-4567 - Phone
- (980) 242-7090
- NPI assigned
- Apr 6, 2022
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | P015235 | NC | Primary |
Addresses
Primary practice location
10150 Mallard Creek Rd Ste 104
Charlotte, NC 28262-4567
Mailing address
10150 Mallard Creek Rd Ste 104
Charlotte, NC 28262-4567
Phone (980) 242-7090
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 |
|---|---|---|---|
| P015235 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649203200000",
"number": "1811638562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10150 MALLARD CREEK RD STE 104",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282624567",
"telephone_number": "980-242-7090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10150 MALLARD CREEK RD STE 104",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282624567",
"telephone_number": "980-242-7090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ACACIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-06",
"last_updated": "2022-04-06",
"certification_date": "2022-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P015235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
- Wilora Lake Healthcare LLC
- Elizabeth Oludayo Wilson-Durham, FNP
- Roxanne Annesa Wilson-Miller, LCSW
- Heather Dawn Wilson-Shelton
- Aaron Everett Wilson, MD
- Aghashiyah Al'Haqqah Muhammad Wilson, LCSW-A
- Alecia Marie Wilson, FNP-C
- Alicia Shardae Wilson, PT, DPT
- Ariel Wilson, LCSWA
- Arthur Scott Wilson, LCMHCA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.