Individual
TERESA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2711 COLONIAL DR, COLUMBIA, SC 29203-6818
(803) 726-9300
Mailing address
2711 COLONIAL DR, COLUMBIA, SC 29203-6818
(803) 726-9300
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/30/2014
Last updated
04/30/2014
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