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Individual
JUAN WILSON
Active
Individual
JUAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, LCAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001672A
IN
1041C0700X
Clinical Social Worker
34010348A
IN
Other
Enumeration date
11/14/2022
Last updated
05/11/2023
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