Provider Demographics
NPI:1720707524
Name:WILSON-SNOW, STACY ALICIA
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ALICIA
Last Name:WILSON-SNOW
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 1:1348 OAK ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3430
Mailing Address - Country:US
Mailing Address - Phone:202-368-5213
Mailing Address - Fax:
Practice Address - Street 1:1348 OAK ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3430
Practice Address - Country:US
Practice Address - Phone:202-368-5213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional