Individual
DEMETRIS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16460 VICTOR ST, VICTORVILLE, CA 92395-3918
(760) 245-8837
(760) 245-8893
Mailing address
16460 VICTOR ST, VICTORVILLE, CA 92395-3918
(760) 245-8837
(760) 245-8893
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/17/2010
Last updated
09/17/2010
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