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Individual
NICKIE DEANN WILSON
Active
Individual
NICKIE DEANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC/MH
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1345
OK
171M00000X
Case Manager/Care Coordinator
—
NULL
Other
Enumeration date
07/11/2016
Last updated
03/31/2021
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