| NPI | 1053476408 |
|---|---|
| Former Name | NIKKI WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 05-11-105) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-08 |