Individual
SHANDRA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4500 I 55 N STE 223, JACKSON, MS 39211-5931
(337) 764-2065
Mailing address
610 E LEAKE ST, CLINTON, MS 39056-4321
(337) 764-2065
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1835
MS
101YP2500X
Professional Counselor
4151
LA
101YP2500X
Professional Counselor
70098
TX
Other
Enumeration date
08/07/2014
Last updated
11/13/2020
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