Individual
MS. LESLIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, NCACII
Contact information
Practice address
2323 LADY STREET, COLUMBIA, SC 29204
(803) 210-9554
Mailing address
2323 LADY STREET, COLUMBIA, SC 29204
(803) 210-9554
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
006759
SC
Other
Enumeration date
10/22/2014
Last updated
10/22/2014
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