Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301011837 | MI |
Y | 103G00000X | Clinical Psychologist | 6301011837 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301011837 | MI |
N | 103TP2701X | Group Psychotherapist | 6301011837 | MI |
NPI | 1225349608 |
---|---|
Provider Name | Donald H. Wilson |
First Address | Royal Oak, MI 48067-2767 |
Second Address | Royal Oak, MI 48067-2767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 30/06/2010 |