Individual
JUAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, LCAC
Contact information
Practice address
9623 WINDERMERE BLVD, FISHERS, IN 46037-9180
(888) 416-4646
Mailing address
101 DIAMOND LN, CRAWFORDSVILLE, IN 47933-8320
(765) 918-3923
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001672A
IN
1041C0700X
Clinical Social Worker
34010348A
IN
Other
Enumeration date
11/14/2022
Last updated
05/11/2023
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