Individual
EVET A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
245 W RACE ST, SOMERSET, PA 15501-1922
(814) 443-4891
Mailing address
245 W RACE ST, SOMERSET, PA 15501-1922
(814) 443-4891
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558267185
—
PA
05
—
1558367185
—
PA
Enumeration date
05/07/2020
Last updated
05/07/2020
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