Provider Demographics
NPI:1245906692
Name:WILSON, EPHARIN ELI (CADC)
Entity type:Individual
Prefix:
First Name:EPHARIN
Middle Name:ELI
Last Name:WILSON
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1003
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-6003
Mailing Address - Country:US
Mailing Address - Phone:609-287-7519
Mailing Address - Fax:
Practice Address - Street 1:205 W PARKWAY DR
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5105
Practice Address - Country:US
Practice Address - Phone:609-287-7519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)