Individual
MR. BLAINE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, MED
Contact information
Practice address
3801 CANAL ST STE 220, NEW ORLEANS, LA 70119-6084
(504) 482-2735
(504) 482-2737
Mailing address
3801 CANAL ST STE 220, NEW ORLEANS, LA 70119-6084
(504) 482-2735
(504) 482-2737
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
13231
LA
1041C0700X
Clinical Social Worker
Primary
CW018726
PA
Other
Enumeration date
10/09/2015
Last updated
10/09/2015
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