Individual
CHANTELL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
302 DULLES DR, LAFAYETTE, LA 70506-3008
(337) 262-4905
(337) 262-4160
Mailing address
302 DULLES DR, LAFAYETTE, LA 70506-3008
(337) 262-4905
(337) 262-4160
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
18154
LA
Other
Enumeration date
12/05/2023
Last updated
12/05/2023
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