Individual
JEFF WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDP
Contact information
Practice address
611 W COTA ST, SHELTON, WA 98584-2241
(360) 426-5654
(360) 426-5641
Mailing address
611 W COTA ST, SHELTON, WA 98584-2241
(360) 426-5654
(360) 426-5641
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60391036
WA
Other
Enumeration date
08/06/2015
Last updated
08/06/2015
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