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NPI Code Detail

MEDICARE: ALETA WILSON BSW, CDCS

MEDICARE: ALETA WILSON BSW, CDCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1164080545
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALETA WILSON BSW, CDCS
Provider Business Mailing Address
First Line : 360 W BENSON BLVD STE 300
Second Line :
City : ANCHORAGE
State : AK
Zip : 99503-3953
Country : US
Telephone Number : 907-565-1200
Fax Number :
Provider Business Practice Location Address
First Line : 2804 BERING ST
Second Line :
City : ANCHORAGE
State : AK
Zip : 99503-3820
Country : US
Telephone Number : 907-561-5266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2019
Last Update Date : 01/16/2020

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Directions to “ ALETA WILSON BSW, CDCS” Practice Location

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