Individual
SHAWNICE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23701 MILES RD, CLEVELAND, OH 44128-5473
(216) 763-0800
Mailing address
6503 FULLERTON AVE, CLEVELAND, OH 44105-3444
(412) 304-6339
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/11/2018
Last updated
12/11/2018
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