Individual
MS. ANNETTE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
123 PIKE ST, PORT JERVIS, NY 12771-1824
(845) 856-7576
Mailing address
123 PIKE ST, PORT JERVIS, NY 12771-1824
(845) 856-7576
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37087
NY
Other
Enumeration date
12/27/2021
Last updated
12/27/2021
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