Individual
MISS SHYEASHA TANIKA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-BC, PMHNP-BC
Contact information
Practice address
1911 GADSDEN ST STE 204, COLUMBIA, SC 29201-6400
(803) 254-9767
Mailing address
1911 GADSDEN ST STE 200, COLUMBIA, SC 29201-6400
(803) 254-9767
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
104416
SC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
23783
SC
Other
Enumeration date
07/26/2019
Last updated
06/14/2024
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