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Individual

SHAMBA WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1332 GUST LN, CHESAPEAKE, VA 23323-2930
(757) 270-0526
Mailing address
1332 GUST LN, CHESAPEAKE, VA 23323-2930
(757) 270-0526

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary

Other

Enumeration date
04/28/2025
Last updated
04/28/2025
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