Individual
CHARLIZE BRIELLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
117 W 400 S, SALT LAKE CITY, UT 84101-1916
(801) 428-4257
Mailing address
117 W 400 S, SALT LAKE CITY, UT 84101-1916
(385) 200-0110
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
14239643-6009
UT
1041C0700X
Clinical Social Worker
Primary
14239643-6009
UT
Other
Enumeration date
06/21/2021
Last updated
07/27/2026
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