Individual
GORDON BRUCE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
562 WYOMING AVE, KINGSTON, PA 18704-3721
(570) 552-3760
(570) 552-3765
Mailing address
562 WYOMING AVE, KINGSTON, PA 18704-3721
(570) 552-3760
(570) 552-3765
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CWO13852
PA
Other
Enumeration date
03/06/2009
Last updated
03/06/2009
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