Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 3142 | NC |
N | 103TC0700X | Clinical Psychologist | 3142 | NC |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3142 | NC |
Y | 103G00000X | Clinical Psychologist | 3142 | NC |
Y | 103TC0700X | Clinical Psychologist | 3142 | NC |
NPI | 1568453645 |
---|---|
Provider Name | Dr. Janice R Wilmoth |
First Address | Lowgap, NC 27024-9186 |
Second Address | Dobson, NC 27017-8825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2005 |
Last Update Date | 17/09/2012 |