Individual
CHARLES ISAIAH WILSON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4449 N 12TH ST, SUITE A1, PHOENIX, AZ 85014-4520
(602) 279-1427
(602) 279-1431
Mailing address
4449 N 12TH ST, PHOENIX, AZ 85014-4520
(602) 279-1427
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
3664065
AZ
Other
Enumeration date
01/24/2012
Last updated
12/30/2025
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