Individual
MS. SHIRLEY MARIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.A.S.A.C.
Contact information
Practice address
500 8TH AVE, 3RD FLOOR, NEW YORK, NY 10018-6504
(212) 904-1500
Mailing address
25307 148TH DR, ROSEDALE, NY 11422-2815
(718) 413-2372
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20123
NY
Other
Enumeration date
08/18/2008
Last updated
08/18/2008
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