Healthcare Provider Details

I. General information

NPI: 1366571804
Provider Name (Legal Business Name): SHELIAH FRAZIER WILLS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 EUCLID AVE SUITE 102
SAN DIEGO CA
92114
US

IV. Provider business mailing address

1085 MARJORIE DR
SAN DIEGO CA
92114
US

V. Phone/Fax

Practice location:
  • Phone: 619-266-2111
  • Fax: 619-266-0496
Mailing address:
  • Phone: 619-266-2111
  • Fax: 619-266-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: