Individual
RYAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAC. NCC, CPRP
Contact information
Practice address
15 W PROSPECT ST, EAST BRUNSWICK, NJ 08816-2161
(732) 254-0600
Mailing address
6 OAKWOOD PL, CARTERET, NJ 07008-1510
(732) 713-6772
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
37AC00398600
NJ
Other
Enumeration date
01/15/2019
Last updated
01/15/2019
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