Provider Demographics
NPI:1932863420
Name:WILSON, SALAH (MSW)
Entity Type:Individual
Prefix:
First Name:SALAH
Middle Name:
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 1:29 WILLOW BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6621
Mailing Address - Country:US
Mailing Address - Phone:213-442-9880
Mailing Address - Fax:
Practice Address - Street 1:29 WILLOW BRANCH DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6621
Practice Address - Country:US
Practice Address - Phone:213-442-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health