Individual
MR. EARL WILSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
REV, LMFT
Contact information
Practice address
6205 HANGING MOSS RD, JACKSON, MS 39206-2121
(601) 982-3997
(601) 982-8933
Mailing address
706 COLONIAL CIR, JACKSON, MS 39211-3208
(601) 899-5827
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35001450
IN
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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