Individual
MR. ROBERT WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
41521 W 11 MILE RD, NOVI, MI 48375-1803
(248) 299-0030
Mailing address
17608 FIELDING ST, DETROIT, MI 48219-5219
(313) 402-0898
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361007897
MI
103T00000X
Psychologist
—
MI
106S00000X
Behavior Technician
—
—
Other
Enumeration date
08/29/2017
Last updated
11/20/2023
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