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1699221945
DEWIGHT EDWIN WILSON
VALLEJO, CA
NPI
1699221945
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA 11966)
Enumeration Date
2016-08-28
Last Update Date
2016-08-28
Business Address
Mr. DEWIGHT EDWIN WILSON RADT1
419 PENNSYLVANIA ST
VALLEJO, CA 94590-6933
Phone number: 707-643-2715
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Mailing Address
Mr. DEWIGHT EDWIN WILSON RADT1
419 PENNSYLVANIA ST.
VALLEJO, CA 94590
Phone number: 707-643-2715
Copy
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