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Individual

MS. THERESA ANN WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
MILEPOST 388 HIGHWAY 264, POLACCA, AZ 86042-4000
(928) 737-6188
(928) 737-6098
Mailing address
PO BOX 4000, POLACCA, AZ 86042-4000
(928) 737-6188
(928) 737-6098

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0698081
NY

Other

Enumeration date
07/12/2013
Last updated
07/12/2013
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