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Individual
LARRY DWIGHT WILSON JR.
Active
Individual
LARRY DWIGHT WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHP, LADC, CPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
819
NE
101YM0800X
Mental Health Counselor
3523
NE
101YP2500X
Professional Counselor
1770
NE
Other
Enumeration date
01/04/2008
Last updated
05/09/2012
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