Individual
ELIZABETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
63 WALL ST, MADISON, CT 06443-3121
(203) 318-4224
Mailing address
PO BOX 179, MADISON, CT 06443-0179
(203) 318-4224
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1169
CT
106H00000X
Marriage & Family Therapist
Primary
1848
CT
Other
Enumeration date
10/30/2015
Last updated
01/25/2017
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