Individual
MS. MILLIE B WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1113 PORTER ST APT C, VALLEJO, CA 94590-7910
(505) 977-1316
Mailing address
1113 PORTER ST APT C, VALLEJO, CA 94590-7910
(505) 977-1316
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 21765
CA
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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