Individual
LARRY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15719 CRABBS BRANCH WAY, ROCKVILLE, MD 20855-2634
(301) 670-6161
(201) 670-6163
Mailing address
15719 CRABBS BRANCH WAY, ROCKVILLE, MD 20855-2634
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCA461
MD
Other
Enumeration date
03/02/2015
Last updated
03/02/2015
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