Provider Demographics
NPI:1053144980
Name:WILSON, KEVIN (CADC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:WILSON
Suffix:
Gender:X
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 S COMMERCE WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8992
Mailing Address - Country:US
Mailing Address - Phone:610-264-5521
Mailing Address - Fax:610-419-0763
Practice Address - Street 1:31 S COMMERCE WAY STE 300
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8992
Practice Address - Country:US
Practice Address - Phone:610-264-5521
Practice Address - Fax:610-419-0763
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)