Individual
COBY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
215 N G ST, LAKEVIEW, OR 97630-1417
(541) 947-6021
Mailing address
215 N G ST, LAKEVIEW, OR 97630-1417
(541) 947-6021
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
24-10-11280
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
06/16/2023
Last updated
11/04/2024
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