Individual
ANDRE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S.
Contact information
Practice address
9017 MORAY DR, SHREVEPORT, LA 71129-5127
(318) 218-0761
Mailing address
9017 MORAY DR, SHREVEPORT, LA 71129-5127
(318) 218-0761
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/12/2017
Last updated
01/12/2017
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