Individual
MR. DALLAS RANDALL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LSW
Contact information
Practice address
16 SW 5TH ST, RICHMOND, IN 47374-4101
(765) 288-1928
(765) 935-1582
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
(765) 741-0335
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/05/2011
Last updated
11/21/2014
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