Individual
LARRY DWIGHT WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHP, LADC, CPC
Contact information
Practice address
3020 18TH ST SUITE 17, CATHOLIC CHARITIES, COLUMBUS, NE 68601-4254
(402) 563-3833
(402) 562-8714
Mailing address
3300 N 60TH ST, CATHOLIC CHARITIES, OMAHA, NE 68104-3402
(402) 554-0520
(402) 551-8797
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
819
NE
101YM0800X
Mental Health Counselor
3523
NE
101YP2500X
Professional Counselor
1770
NE
Other
Enumeration date
01/04/2008
Last updated
05/09/2012
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