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Individual

MR. SHANNON THADIO WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3600 GOVERNMENT ST, ALEXANDRIA, LA 71302-3324
(318) 441-1105
Mailing address
3600 GOVERNMENT ST, ALEXANDRIA, LA 71302-3324
(318) 441-1105

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4210
LA
101YA0400X
Addiction (Substance Use Disorder) Counselor

Other

Enumeration date
09/16/2016
Last updated
12/29/2022
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