Individual
JENISE DELORES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPCC
Contact information
Practice address
1110 COLLEGE DR STE 206, BISMARCK, ND 58501-1207
(701) 258-2008
Mailing address
507 N 27TH ST, BISMARCK, ND 58501-3115
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
786-6-1-14
ND
101YP2500X
Professional Counselor
Primary
786-6-1-14-293
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1472904
—
ND
Enumeration date
07/10/2017
Last updated
10/20/2022
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