Individual
MR. DAVID CHARLES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Mailing address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
T0472A
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018213
—
MS
Enumeration date
08/09/2013
Last updated
08/09/2013
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