Provider Demographics
NPI:1306408729
Name:WILSON, ZHA'NAE LA'GRACIE
Entity Type:Individual
Prefix:
First Name:ZHA'NAE
Middle Name:LA'GRACIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 CARRIAGE HOUSE CIR APT 3604
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4454
Mailing Address - Country:US
Mailing Address - Phone:682-561-8882
Mailing Address - Fax:975-767-0722
Practice Address - Street 1:1823 CARRIAGE HOUSE CIR APT 3604
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4454
Practice Address - Country:US
Practice Address - Phone:682-561-8882
Practice Address - Fax:975-767-0722
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator