Individual
MRS. DEMECKA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1138 PUFFER RD, FAYETTE, MS 39069-5133
(601) 472-2310
Mailing address
1644 B CARTER STREET SUITE 2, VIDALIA, LA 71373
(318) 414-3065
(318) 414-3067
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Enumeration date
03/14/2016
Last updated
07/30/2021
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