Provider Demographics
NPI:1508011321
Name:WILSON, LEVEN II
Entity Type:Individual
Prefix:MR
First Name:LEVEN
Middle Name:
Last Name:WILSON
Suffix:II
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6350 W MACLAURIN DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1164
Mailing Address - Country:US
Mailing Address - Phone:813-455-1826
Mailing Address - Fax:
Practice Address - Street 1:7920 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1613
Practice Address - Country:US
Practice Address - Phone:813-997-9893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator