Individual
ANTWAIN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5300 W AVENUE I, LANCASTER, CA 93536-8312
(661) 940-4052
Mailing address
5300 W AVENUE I, LANCASTER, CA 93536-8312
(661) 940-4052
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
IMF73683
CA
Other
Enumeration date
09/29/2014
Last updated
09/29/2014
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