Provider Demographics
NPI:1790184505
Name:WILSON, NAKIA DANINE (MSW, LCSW, LSCSW,RPT)
Entity Type:Individual
Prefix:MRS
First Name:NAKIA
Middle Name:DANINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW, LCSW, LSCSW,RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-4720
Mailing Address - Country:US
Mailing Address - Phone:816-520-9048
Mailing Address - Fax:
Practice Address - Street 1:9600 E 87TH ST
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-4720
Practice Address - Country:US
Practice Address - Phone:816-520-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110169891041C0700X
KS41111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical