Individual provider · Type 1 NPI

Jerry Wilson

Addiction (Substance Use Disorder) Counselor · Shiprock, NM

NPI number 1962731786 Active

Practice location

Hwy 491 N. Pinon St., Red Modular Bldg
Shiprock, NM 87420-1830

Call (505) 368-1050 Map

Fax (505) 368-1055

Mailing address

PO Box 1830
Shiprock, NM 87420-1830

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X0122591 (NM)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1962731786

Jerry Wilson's National Provider Identifier is 1962731786, issued on Dec 8, 2009. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Shiprock, NM. The record was last updated on Dec 8, 2009.