Individual
DR. MARK WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4951 CENTRAL AVE, MONROE, LA 71203-6156
(318) 340-1535
(318) 340-1539
Mailing address
4951 CENTRAL AVE, MONROE, LA 71203-6156
(318) 340-1535
(318) 340-1539
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2331
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600723230
—
LA
Enumeration date
09/30/2015
Last updated
08/01/2016
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