Individual
MR. NICHOLAS FREDERICK WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSW,CASAC
Contact information
Practice address
11630 SUTPHIN BLVD, JAMAICA, NY 11434-1527
(718) 322-2500
(718) 322-1881
Mailing address
11630 SUTPHIN BLVD, JAMAICA, NY 11434-1527
(718) 322-2500
(718) 322-1881
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20345
NY
Other
Enumeration date
12/10/2015
Last updated
12/10/2015
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