Individual
JERWIN JERMAINE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7505 PINES RD, SHREVEPORT, LA 71129-3935
(318) 562-3707
Mailing address
6057 FOX CHASE TRL, SHREVEPORT, LA 71129-3540
(318) 436-1022
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/14/2017
Last updated
04/14/2017
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