Individual
RICHARD WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
1421 LUISA ST STE C, SANTA FE, NM 87505-4073
(505) 231-4804
Mailing address
1421 LUISA ST STE C, SANTA FE, NM 87505-4073
(505) 231-4804
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0132231
NM
Other
Enumeration date
07/13/2010
Last updated
07/13/2010
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