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1831243054
LEROY WILSON GLENN
LEXINGTON, NC
NPI
1831243054
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: NC 688)
Enumeration Date
2007-01-23
Last Update Date
2007-07-08
Business Address
LEROY WILSON GLENN LCAS
220 EAST FIRST AVENUE EXTENSION SUITE 10
LEXINGTON, NC 27292-3355
Phone number: 336-242-2450
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Mailing Address
LEROY WILSON GLENN LCAS
1404 SANTOLINA LN
LEWISVILLE, NC 27023-8622
Phone number:
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