Active NPI
John F. Wilson III
- Psychologist
- West End, NC
National Provider Identifier
1962524207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2300
- Practice address
- 1135 Seven Lakes Drive
Suite D
West End, NC 27376 - Phone
- (910) 638-4560
- NPI assigned
- Apr 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 11
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2300 | NC | Primary |
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | 2300 | NC | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 2300 | NC | |
| Clinical Psychologist | 103TC0700X | 2300 | NC | |
| Counseling Psychologist | 103TC1900X | 2300 | NC | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 2300 | NC | |
| Health Service Psychologist | 103TH0100X | 2300 | NC | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 2300 | NC | |
| Group Psychotherapy Psychologist | 103TP2701X | 2300 | NC | |
| Rehabilitation Psychologist | 103TR0400X | 2300 | NC | |
| School Psychologist | 103TS0200X | 2300 | NC |
Addresses
Primary practice location
1135 Seven Lakes Drive
Suite D
West End, NC 27376
Mailing address
PO Box 912
West End, NC 27376-0912
Other practice location 1
10 Parker Ln
Suite 1
Pinehurst, NC 28374-7903
Phone (910) 295-3133 ext. 227
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3403400 | Medicaid | NC | |
| 13973 | Other | NC | BCBS |
| 562033116 | Other | NC | TRICARETAX ID |
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 |
|---|---|---|---|
| 2300 | NC | MD | Rehabilitation Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1962524207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 912",
"city": "WEST END",
"state": "NC",
"postal_code": "273760912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1135 SEVEN LAKES DRIVE",
"address_2": "SUITE D",
"city": "WEST END",
"state": "NC",
"postal_code": "27376",
"telephone_number": "910-638-4560"
}
],
"practiceLocations": [
{
"address_1": "10 Parker Ln",
"address_2": "Suite 1",
"address_purpose": "LOCATION",
"city": "Pinehurst",
"state": "NC",
"postal_code": "283747903",
"country_code": "US",
"telephone_number": "910-295-3133 x227",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "JOHN",
"middle_name": "F.",
"name_suffix": "III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-06",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "2300",
"primary": true
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "2300",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NC",
"license": "2300",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "2300",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "NC",
"license": "2300",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NC",
"license": "2300",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "NC",
"license": "2300",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "NC",
"license": "2300",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "NC",
"license": "2300",
"primary": false
},
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "NC",
"license": "2300",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NC",
"license": "2300",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3403400",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "13973",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARETAX ID",
"identifier": "562033116",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in West End, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.