Provider Demographics
NPI:1497151906
Name:SANTIAGO, WILSON JR (MS, BSL)
Entity Type:Individual
Prefix:MR
First Name:WILSON
Middle Name:
Last Name:SANTIAGO
Suffix:JR
Gender:M
Credentials:MS, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 S DUKE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-2713
Mailing Address - Country:US
Mailing Address - Phone:717-413-6826
Mailing Address - Fax:
Practice Address - Street 1:513 S DUKE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-2713
Practice Address - Country:US
Practice Address - Phone:717-413-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health