Individual
MR. BENJAMIN RUSSELL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLPC
Contact information
Practice address
6461 DAWN DR, BELLEVUE, MI 49021-8411
(269) 986-2844
Mailing address
6461 DAWN DR., BELLEVUE, MI 49021
(269) 986-2844
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401015351
MI
Other
Enumeration date
11/16/2016
Last updated
11/16/2016
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