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1063957801
SHANGA WILSON
JACKSONVILLE, FL
NPI
1063957801
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-01-04
Last Update Date
2017-01-04
Business Address
-- SHANGA WILSON
590 ELLIS RD S
JACKSONVILLE, FL 32254-3555
Phone number: 904-800-2231
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Mailing Address
-- SHANGA WILSON
590 ELLIS RD S
JACKSONVILLE, FL 32254-3555
Phone number: 904-800-2231
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