Individual
IVORY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LAC, CCDP-D,
Contact information
Practice address
440 N FOSTER DR FL 2, BATON ROUGE, LA 70806-3561
(225) 283-1447
(844) 947-4494
Mailing address
440 N FOSTER DR FL 2, BATON ROUGE, LA 70806-3561
(225) 283-1447
(844) 947-4494
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/29/2024
Last updated
04/29/2024
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