Individual
SHAVONA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
9168 ELLIE DR # B, PHILADELPHIA, PA 19114-2857
(856) 412-1769
Mailing address
9168 ELLIE DR # B, PHILADELPHIA, PA 19114-2857
(856) 412-1769
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW139889
PA
Other
Enumeration date
07/14/2023
Last updated
07/14/2023
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