Individual
MS. KIMBERLY PATRICE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
205 NORTH LIBERTY ST, CENTREVILLE, MD 21617
(410) 758-1306
(410) 758-2133
Mailing address
205 N LIBERTY ST, CENTREVILLE, MD 21617-1022
(410) 758-1306
(410) 758-2133
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
TRAINEE
MD
Other
Enumeration date
08/29/2013
Last updated
08/29/2013
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