Individual
MRS. SHIRLEY JO WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1200 N WEST AVE, JACKSON, MI 49202-2179
(517) 789-1209
Mailing address
5088 TOWNLEY HWY, MANITOU BEACH, MI 49253-9784
(517) 403-4950
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12550792
CAQH
MI
Enumeration date
04/22/2009
Last updated
10/30/2024
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