Individual
DEMETRIUS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5060 N 19TH AVE STE 300-21, PHOENIX, AZ 85015-3210
(480) 853-5514
Mailing address
PO BOX 621, JAMESTOWN, NC 27282-0621
(336) 884-2162
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/01/2022
Last updated
11/01/2022
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