Provider Demographics
NPI:1245018647
Name:WILSON, SHEMYA (LSW)
Entity type:Individual
Prefix:MS
First Name:SHEMYA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 WATERFALL LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3315
Mailing Address - Country:US
Mailing Address - Phone:614-900-0068
Mailing Address - Fax:
Practice Address - Street 1:5050 BLAZER PKWY STE 101
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3361
Practice Address - Country:US
Practice Address - Phone:614-252-0731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS.2411030104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator