Provider Demographics
NPI:1467090753
Name:WILTSHIRE, RICHELLE ANIQUE
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:ANIQUE
Last Name:WILTSHIRE
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:PO BOX 4775
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-4775
Mailing Address - Country:US
Mailing Address - Phone:340-201-7546
Mailing Address - Fax:
Practice Address - Street 1:5030 ANCHOR WAY STE 9
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4692
Practice Address - Country:US
Practice Address - Phone:340-719-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty