Individual
ISHALON SHANQUELL SIEDAH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, LPC
Contact information
Practice address
4090 SW JAQUST ST, PORT ST LUCIE, FL 34953-5626
(850) 631-0977
Mailing address
4090 SW JAQUST ST, PORT ST LUCIE, FL 34953-5626
(850) 631-0977
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MH23967
FL
101YP2500X
Professional Counselor
Primary
99718
TX
Other
Enumeration date
06/25/2024
Last updated
01/20/2026
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