Individual
HOLLY K WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 SUNSET LOOP, MESCALERO, NM 88340
(575) 464-4338
(575) 464-4331
Mailing address
PO BOX 228, MESCALERO, NM 88340-0228
(575) 464-4338
(575) 464-4331
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0119501
NM
Other
Enumeration date
04/21/2010
Last updated
04/21/2010
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