Individual
MARIA ANTIONETTA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S WASHINGTON ST, MARION, IN 46952-3867
(765) 662-9971
Mailing address
8401 HARCOURT RD, INDIANAPOLIS, IN 46260-2036
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
33007946A
IN
1041C0700X
Clinical Social Worker
Primary
34009408A
IN
Other
Enumeration date
03/05/2018
Last updated
09/30/2021
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