Basic Information
| Provider Information | |||||||||
| NPI: | 1467947960 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLAY, WILSON & ASSOCAITES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4330 VIOLA SIPE DR | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286138839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282563436 | ||||||||
| FaxNumber: | 8282563623 | ||||||||
| Practice Location | |||||||||
| Address1: | 929 15TH ST NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286014162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283276026 | ||||||||
| FaxNumber: | 8283278796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2018 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8282563436 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CLAY, WILSON & ASSOCAITES, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 251S00000X | N | Agencies | Community/Behavioral Health | 251S00000X | MHL-018-056 | NC | Y | Agencies | Community/Behavioral Health |
No ID Information.