Basic Information
| Provider Information | |||||||||
| NPI: | 1619370244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLAY, WILSON & ASSOCAITES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE COGNITIVE CONNECTION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4330 VIOLA SIPE DR | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282563436 | ||||||||
| FaxNumber: | 8282563623 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 E MEETING ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286553598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286241927 | ||||||||
| FaxNumber: | 8284386938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2014 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8282563436 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.