Individual
DESTANY ALEXANDRA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
405 UTAH AVE, ALAMOGORDO, NM 88310-5930
(979) 525-8814
Mailing address
405 UTAH AVE, ALAMOGORDO, NM 88310-5930
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/01/2020
Last updated
05/01/2020
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