Individual
MS. ANGELIQUE EMILY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6030 E STATE BLVD, FORT WAYNE, IN 46815-7639
(260) 245-6374
Mailing address
6030 E STATE BLVD, FORT WAYNE, IN 46815-7639
(260) 245-6374
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
104100000X
Social Worker
—
—
Other
Enumeration date
12/11/2023
Last updated
12/11/2023
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