Individual
MS. SUSAN ANNETTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED
Contact information
Practice address
3715 BARDSTOWN ROAD, SUITE 415, FAMILY LINKS, LOUISVILLE, KY 40218
(502) 639-0152
Mailing address
1733 BONNYCASTLE AVE, LOUISVILLE, KY 40205-1014
(502) 417-9881
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
KY-1002
KY
103TC1900X
Counseling Psychologist
Primary
KY-0488
KY
Other
Enumeration date
12/23/2005
Last updated
09/15/2014
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