Provider Demographics
NPI:1619096393
Name:WILSON, SHANIKA LAVI (DSW, LCAS, LCSW)
Entity Type:Individual
Prefix:DR
First Name:SHANIKA
Middle Name:LAVI
Last Name:WILSON
Suffix:
Gender:F
Credentials:DSW, LCAS, LCSW
Other - Prefix:
Other - First Name:SHANIKA
Other - Middle Name:LAVI
Other - Last Name:RENFRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, MSW
Mailing Address - Street 1:9241 WILLEY ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-4826
Mailing Address - Country:US
Mailing Address - Phone:919-545-4700
Mailing Address - Fax:
Practice Address - Street 1:9241 WILLEY ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-4826
Practice Address - Country:US
Practice Address - Phone:919-545-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2795101YA0400X
NCC0066041041C0700X
CT0071701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)