Individual
FREDRICK WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4601 N MARKET ST, SHREVEPORT, LA 71107-2971
(318) 424-8735
(318) 424-8739
Mailing address
PO BOX 5, RODESSA, LA 71069-0005
(318) 223-4665
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/24/2017
Last updated
07/21/2022
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