Individual
FRAZIER CLETHON WILSON JR.
Active
Individual
FRAZIER CLETHON WILSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW, LADAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0093531
NM
1041C0700X
Clinical Social Worker
Primary
I-06709
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0093531
LICENSE
NM
01
—
I-06709
LICENSE
NM
Enumeration date
10/16/2006
Last updated
12/07/2009
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