Individual
NICOLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1 N MAIN ST, COUDERSPORT, PA 16915-1630
(814) 274-8651
Mailing address
49 LEFEVER RD, COUDERSPORT, PA 16915-8362
(814) 203-0022
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW141371
PA
Other
Enumeration date
09/11/2024
Last updated
09/11/2024
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