Individual
BENJAMIN MARTIN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4010 DUPONT CIR STE 582, LOUISVILLE, KY 40207-4888
(502) 899-5411
Mailing address
17313 CURRY BRANCH RD, LOUISVILLE, KY 40245-7501
(502) 930-5745
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
248552
KY
Other
Enumeration date
09/04/2019
Last updated
09/04/2019
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