Individual
CHARLES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
810 CLASSON AVE, BROOKLYN, NY 11238-6102
(718) 230-5100
(718) 230-5145
Mailing address
1 KEMP AVE, GLEN COVE, NY 11542-3525
(516) 412-5145
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
34352
NY
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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