Individual
ANTANITA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4852 POLAR LIGHTS CT, LAS VEGAS, NV 89130-7275
(702) 826-7250
Mailing address
4852 POLAR LIGHTS CT, LAS VEGAS, NV 89130-7275
(702) 826-7250
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/03/2023
Last updated
11/03/2023
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