Individual
MRS. CARMEN MARIA WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADAC
Contact information
Practice address
2200 BERQUIST DRIVE, SUITE 1, LACKLAND AFB, TX 78236
(210) 292-4452
Mailing address
2200 BERQUIST DRIVE, SUITE 1, LACKLAND AFB, TX 78236
(210) 292-4452
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2042
DC
Other
Enumeration date
09/29/2009
Last updated
09/29/2009
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