Stacy Natasha Wilson, PSY.D., LCAS, MAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Winton, NC
NPI 1992261085 · NPPES record last updated Feb 14, 2019
Key facts
- NPI
- 1992261085
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- LCAS-3290 (NC)
- Practice address
- 145 Parker Fishery Rd
Winton, NC 27986-9763 - Phone
- (252) 358-5200
- NPI assigned
- Feb 14, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-3290 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| 4371 | NC | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 4371 | NC | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCAS-3290 | NC | Yes |
Addresses
Primary practice location
145 Parker Fishery Rd
Winton, NC 27986-9763
Mailing address
1014 Island Park Cir
Suffolk, VA 23435-3275
Other practice location 1
1014 Island Park Cir
Suffolk, VA 23435-3275
Phone (646) 244-9493
Other providers in Winton, NC
- County of Hertford
- D L Story & Associates PLLC
- Deborah L Story, PSYD, PLLC
- Hall'S Family Care Home
- Hertford County Public Schools
All providers in Winton, NC · Addiction (Substance Use Disorder) Counselor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.