Individual
JASON LUKE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 ELIZABETH PL, DAYTON, OH 45417-3445
(937) 813-1737
Mailing address
1 ELIZABETH PL, DAYTON, OH 45417-3445
(937) 813-1737
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.189003
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0411413
—
OH
Enumeration date
10/04/2023
Last updated
07/10/2024
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