Provider Demographics
NPI:1568189587
Name:WILSON, JAMES LESTER (CDCA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LESTER
Last Name:WILSON
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19600 EUCLID AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1437
Mailing Address - Country:US
Mailing Address - Phone:216-414-1013
Mailing Address - Fax:
Practice Address - Street 1:19600 EUCLID AVE APT 207
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1437
Practice Address - Country:US
Practice Address - Phone:216-414-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH182190101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty