Provider Demographics
NPI:1396098083
Name:WILSON, CHRISTINA YEVETTE (MSW)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:YEVETTE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 KNIGHT ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2709
Mailing Address - Country:US
Mailing Address - Phone:240-291-6311
Mailing Address - Fax:
Practice Address - Street 1:1940 MARAVILLA AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7135
Practice Address - Country:US
Practice Address - Phone:239-334-0222
Practice Address - Fax:239-334-0244
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor