Individual
LISA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, PROVISIONAL
Contact information
Practice address
7027 MONTGOMERY BLVD NE STE F, ALBUQUERQUE, NM 87109-1529
(505) 880-0100
Mailing address
7027 MONTGOMERY BLVD NE STE F, ALBUQUERQUE, NM 87109-1529
(505) 880-0100
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
T-0181151
NM
Other
Enumeration date
10/13/2016
Last updated
10/13/2016
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