Individual
MS. BETTY JEAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICDC-CS
Contact information
Practice address
2447 NEBRASKA AVE, TOLEDO, OH 43607-3531
(419) 255-4444
Mailing address
2447 NEBRASKA AVE, TOLEDO, OH 43607-3531
(419) 255-4444
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
913005
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
913005
PROVIDER LICENSE LICDC-CS
OH
Enumeration date
02/19/2020
Last updated
02/19/2020
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