Individual
SHANE' ROLANDA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5121 KINGDOM WAY STE 100, RALEIGH, NC 27607-6063
(919) 743-0204
Mailing address
5121 KINGDOM WAY STE 100, RALEIGH, NC 27607-6063
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1447
NC
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
09/12/2019
Last updated
11/04/2024
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