Individual
MR. JUSTIN WIXSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCAT
Contact information
Practice address
23 E MARKET ST, SUITE H, RHINEBECK, NY 12572-1639
(315) 380-3211
Mailing address
27 VIOLET PL, RHINEBECK, NY 12572-1621
(315) 380-3211
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
001790
NY
Other
Enumeration date
01/25/2016
Last updated
01/25/2016
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