Individual
MARY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
915 AVENUE B, NEDERLAND, TX 77627-2902
(228) 365-5539
Mailing address
915 AVENUE B, NEDERLAND, TX 77627-2902
(228) 365-5539
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
58442
TX
Other
Enumeration date
10/05/2015
Last updated
10/05/2015
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