Individual
DAIVON MALEKE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1619 COLLINS RD NW STE 500, KENNESAW, GA 30152-8237
(470) 531-0430
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
(866) 610-0850
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/28/2023
Last updated
07/28/2023
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