Individual
KRISTINE D WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
368 COURTHOUSE RD STE D, GULFPORT, MS 39507-1854
(228) 341-1079
Mailing address
15256 THREE RIVERS RD, BILOXI, MS 39532-8066
(228) 341-1079
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2131
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05278341
—
MS
Enumeration date
04/21/2017
Last updated
09/07/2024
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