JERRY WILSON

SHIPROCK, NM
NPI1962731786
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NM  0122591)
Enumeration Date2009-12-08
Last Update Date2009-12-08
Business Address
Mr. JERRY WILSON
HWY 491 N. PINON ST. RED MODULAR BLDG
SHIPROCK, NM 87420-1830
Phone number: 505-368-1050
Mailing Address
Mr. JERRY WILSON
PO BOX 1830
SHIPROCK, NM 87420-1830
Phone number: 505-368-1050
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