Individual
CHARLES WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
48 RANDOLPH ST, WILMINGTON, OH 45177-2731
(937) 481-5647
Mailing address
157 N SOUTH ST, WILMINGTON, OH 45177-1646
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
04/11/2022
Last updated
02/22/2023
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