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Individual

DAVID WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LLPC

Contact information

Practice address
781 KENMOOR AVE SE STE C, GRAND RAPIDS, MI 49546-8624
(616) 200-4433
Mailing address
5844 DIX DR NE, BELMONT, MI 49306-9059

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401019214
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
W425135661744
DRIVER'S LICENSE
MI
Enumeration date
07/12/2021
Last updated
07/12/2021
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