Individual
MR. STANLEY BREWSTER WILSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAC-AD
Contact information
Practice address
1501 DIVISION ST, BALTIMORE, MD 21217-3121
(410) 383-7169
(410) 383-3131
Mailing address
1501 DIVISION ST, BALTIMORE, MD 21217-3121
(410) 383-7169
(410) 383-3131
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AC1048
MD
Other
Enumeration date
05/19/2008
Last updated
05/19/2008
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