Provider Demographics
NPI:1710494034
Name:WILSON, SABRINA AQUINN (RBT)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:AQUINN
Last Name:WILSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 TANGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38114-6742
Mailing Address - Country:US
Mailing Address - Phone:901-262-0127
Mailing Address - Fax:
Practice Address - Street 1:1197 TANGLEWOOD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-6742
Practice Address - Country:US
Practice Address - Phone:901-262-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst