Provider Demographics
NPI:1851915722
Name:WILSON, SHEREE COLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHEREE
Middle Name:COLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHEREE
Other - Middle Name:A
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6851 B 112TH STREET
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-354-8071
Mailing Address - Fax:
Practice Address - Street 1:6851 B 112TH STREET
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-354-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-45201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical