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Individual

SUSAN CLEMENT WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSC, MA, LGC, LMHC

Contact information

Practice address
5 DULCE RD, SANTA FE, NM 87508-8284
(505) 577-8480
(505) 466-2183
Mailing address
5 DULCE RD, SANTA FE, NM 87508-8284
(505) 577-8480
(505) 466-2183

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0118861
NM
170300000X
Genetic Counselor (M.S.)
Primary
GC2009-012
NM

Other

Enumeration date
01/23/2009
Last updated
08/07/2009
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