Provider Demographics
NPI:1699808840
Name:SPANN-WILSON, TAI AMRI
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:AMRI
Last Name:SPANN-WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 60TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2352
Mailing Address - Country:US
Mailing Address - Phone:484-326-8131
Mailing Address - Fax:
Practice Address - Street 1:1056 60TH ST.
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608
Practice Address - Country:US
Practice Address - Phone:484-326-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor