Individual
CARMEN DOLORES WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
433 NE 17TH ST APT 7, MCMINNVILLE, OR 97128-3303
(714) 812-3992
Mailing address
627 NE EVANS ST, MCMINNVILLE, OR 97128-3923
(503) 434-7523
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
175T00000X
Peer Specialist
Primary
—
OR
Other
Enumeration date
09/09/2021
Last updated
07/26/2022
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