Individual
MR. WILLIE J WILSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAC-AD
Contact information
Practice address
3111 CLIFTON AVE, BALTIMORE, MD 21216-2734
(443) 271-2874
Mailing address
3916 ANNELLEN RD, BALTIMORE, MD 21215-7215
(443) 271-2874
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AC-1150
MD
Other
Enumeration date
05/28/2021
Last updated
05/28/2021
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