Individual
KHIANTI M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3308 TULANE AVE STE 407, NEW ORLEANS, LA 70119-7158
(504) 821-6830
Mailing address
4996 NOTTINGHAM DR, NEW ORLEANS, LA 70127-3114
(504) 259-5342
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
251500000X
LA
Other
Enumeration date
04/21/2016
Last updated
04/21/2016
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