Individual
CAROLYN DENISE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
105 BERTHA RD, TAOS, NM 87571-7148
(401) 323-1432
Mailing address
176 MAESTAS RD UNIT B, RANCHOS DE TAOS, NM 87557-9779
(401) 323-1432
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CMH0215151
NM
Other
Enumeration date
08/04/2021
Last updated
08/04/2021
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