Individual
KIMBERLI LEESA WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
31 6TH ST, MALONE, NY 12953-1246
(518) 483-3261
Mailing address
31 6TH ST, MALONE, NY 12953-1246
(518) 483-3261
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
36737
NY
175T00000X
Peer Specialist
—
—
Other
Enumeration date
06/05/2017
Last updated
07/21/2022
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