Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003326984 |
---|---|
Provider Name | Dr. Alexis Densie Blue-Wilson |
First Address | Fayetteville, NC 28311-3030 |
Second Address | Sanford, NC 27330-4151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2017 |
Last Update Date | 02/02/2022 |