Provider Demographics
NPI:1639676604
Name:WILCOX, SHAQUERA M
Entity Type:Individual
Prefix:
First Name:SHAQUERA
Middle Name:M
Last Name:WILCOX
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 1:77 MILLSTREAM RD
Mailing Address - Street 2:
Mailing Address - City:PINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-6447
Mailing Address - Country:US
Mailing Address - Phone:856-861-5448
Mailing Address - Fax:856-599-8300
Practice Address - Street 1:77 MILLSTREAM RD
Practice Address - Street 2:
Practice Address - City:PINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:08021-6447
Practice Address - Country:US
Practice Address - Phone:856-861-5448
Practice Address - Fax:856-599-8300
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health