Individual
CAROLYN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3007 LOGAN ST, DISTRICT HEIGHTS, MD 20747-2728
(202) 621-4742
Mailing address
3007 LOGAN ST, DISTRICT HEIGHTS, MD 20747-2728
(202) 621-4742
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
07/11/2023
Last updated
03/27/2024
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