Individual
TINA MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4202 N I-10 SERVICE RD W. METAIRIE, LA 70006, METAIRIE, LA 70006
(888) 880-9270
Mailing address
431 AVENUE B, MARRERO, LA 70072-2011
(319) 504-5369
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
LA
Other
Enumeration date
07/18/2023
Last updated
07/18/2023
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