Individual
MYRA LYNETTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ALC
Contact information
Practice address
404 15TH ST N, BIRMINGHAM, AL 35203-1845
(205) 777-4022
Mailing address
752 41ST ST, FAIRFIELD, AL 35064-2318
(205) 213-9554
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
AL
Other
Enumeration date
10/09/2018
Last updated
10/09/2018
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