Individual
MR. GAVIN JOSEPH WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LAC, SWLC
Contact information
Practice address
2825 STOCKYARD RD STE A11, MISSOULA, MT 59808-1544
(406) 543-5531
Mailing address
404 3RD AVE E, KALISPELL, MT 59901-4907
(303) 601-1536
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
BBH-LAC-LIC-62611
MT
Other
Enumeration date
03/17/2023
Last updated
03/17/2023
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