Individual
MS. BRANDI NICOLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PLPC
Contact information
Practice address
301 SOVEREIGN CT STE 211, BALLWIN, MO 63011-4435
(314) 669-6426
Mailing address
4444 W PINE BLVD APT 416, SAINT LOUIS, MO 63108-2349
(618) 530-0613
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2020022458
MO
Other
Enumeration date
12/14/2020
Last updated
12/14/2020
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