Provider Demographics
NPI:1891556981
Name:WILSON, UNIKA SHANQUELLA
Entity Type:Individual
Prefix:
First Name:UNIKA
Middle Name:SHANQUELLA
Last Name:WILSON
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 1:375 NE 32ND CT UNIT 108
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-5384
Mailing Address - Country:US
Mailing Address - Phone:786-419-7847
Mailing Address - Fax:
Practice Address - Street 1:375 NE 32ND CT UNIT 108
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5384
Practice Address - Country:US
Practice Address - Phone:786-419-7847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician