Individual
MR. DALE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
6126 W STATE ST STE 101, BOISE, ID 83703-2741
(208) 713-9627
Mailing address
7983 W WHITTAKER ST, BOISE, ID 83714-2055
(208) 713-9627
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LCSW - 33650
ID
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCSW - 33650
ID
101YM0800X
Mental Health Counselor
Primary
LCSW - 33650
ID
101YP1600X
Pastoral Counselor
LCSW - 33650
ID
Other
Enumeration date
02/18/2011
Last updated
08/10/2021
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