Individual
TYSHELLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1152 LAY DR, BIRMINGHAM, AL 35215-6938
(205) 821-6754
Mailing address
1152 LAY DR, BIRMINGHAM, AL 35215-6938
(205) 821-6754
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4106C
AL
Other
Enumeration date
01/09/2018
Last updated
01/09/2018
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