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Individual

FRAZIER CLETHON WILSON JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LISW, LADAC

Contact information

Practice address
2418 MILES RD SE, ALBUQUERQUE, NM 87106-3224
(505) 974-7602
(505) 842-1503
Mailing address
2418 MILES RD SE, ALBUQUERQUE, NM 87106-3224
(505) 974-7602
(505) 842-1503

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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