Provider Demographics
NPI:1093231367
Name:HARRISON, WILNEISHA CHARRON (LMSW)
Entity Type:Individual
Prefix:
First Name:WILNEISHA
Middle Name:CHARRON
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:WILNEISHA
Other - Middle Name:CHARRON
Other - Last Name:JAKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:404 S GATEHOUSE DR APT C
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2044
Mailing Address - Country:US
Mailing Address - Phone:504-330-7340
Mailing Address - Fax:
Practice Address - Street 1:404 S GATEHOUSE DR APT C
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2044
Practice Address - Country:US
Practice Address - Phone:504-330-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12377104100000X, 171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker