Individual
BRENDA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 N FOUNTAIN AVE, SPRINGFIELD, OH 45502-1163
(937) 328-5300
(937) 322-4900
Mailing address
2624 LEXINGTON AVE, SPRINGFIELD, OH 45505-2620
(937) 328-5300
(937) 322-4900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCII.161325
OH
Other
Enumeration date
11/06/2017
Last updated
04/23/2019
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