Individual
SHANYA LUCILLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5776 SAINT AUGUSTINE RD, JACKSONVILLE, FL 32207-8046
(904) 572-9798
Mailing address
5776 SAINT AUGUSTINE RD, JACKSONVILLE, FL 32207-8046
(904) 448-4717
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
1992914659
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1871101691
FL
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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