Individual
MR. BRYANT M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
891 MOUNTAIN RANCH RD, SAN ANDREAS, CA 95249-9713
(209) 754-6555
Mailing address
2541 HEINEMANN DR, VALLEY SPRINGS, CA 95252-8854
(209) 772-1621
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/31/2007
Last updated
07/08/2007
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