Individual
MS. SHAINNA SADE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LGPC
Contact information
Practice address
1618 KINGSWAY RD, BALTIMORE, MD 21218-1612
(551) 404-8492
Mailing address
1618 KINGSWAY RD, BALTIMORE, MD 21218-1612
(551) 404-8492
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LGPC7456
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
383876389
—
MD
Enumeration date
03/03/2017
Last updated
03/03/2017
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