| NPI | 1619482908 |
|---|---|
| Former Name | LESLIE ANN WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OR C4666) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C4666) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR C4666) | |
| 101YM0800X Counselor Mental Health (Licence: OR C4666) | |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2017-12-08 |