Individual
BEVERLY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9403 MANSFIELD RD, SHREVEPORT, LA 71118-3815
(903) 701-0425
Mailing address
PO BOX 5, RODESSA, LA 71069-0005
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/26/2016
Last updated
10/26/2016
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