Individual
CORALEEN Y WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6451022370
MI
101YP2500X
Professional Counselor
Primary
6401226225
MI
106S00000X
Behavior Technician
—
—
Other
Enumeration date
08/04/2020
Last updated
05/12/2026
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