Individual
JEFFERY J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 E STATE ST FL 3, ALLIANCE, OH 44601
(330) 821-8503
(330) 627-0088
Mailing address
625 CLEVELAND AVE NW, CANTON, OH 44702-1805
(330) 455-0374
(330) 453-6716
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA172080
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0319802
—
OH
Enumeration date
08/09/2018
Last updated
11/14/2019
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