Individual
BRIAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 W BROADWAY, ANAHEIM, CA 92805-3604
(800) 736-9295
Mailing address
701 W BROADWAY, ANAHEIM, CA 92805-3604
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1618630625
CA
Other
Enumeration date
06/24/2025
Last updated
06/24/2025
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