Individual
ANGEL LYNN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDAC II
Contact information
Practice address
2636 MARYVILLE PIKE, KNOXVILLE, TN 37920-5575
(865) 217-2450
Mailing address
2636 MARYVILLE PIKE, KNOXVILLE, TN 37920-5575
(865) 217-2450
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LDC1294
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LDC1294
LICENSE
TN
Enumeration date
07/18/2022
Last updated
07/18/2022
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