Healthcare Provider Details

I. General information

NPI: 1588861991
Provider Name (Legal Business Name): TASHYA WILSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TASHYA EKECHUKWU PSYD

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

PO BOX 37215
BALTIMORE MD
21297-3215
US

V. Phone/Fax

Practice location:
  • Phone: 301-565-4283
  • Fax: 301-244-6301
Mailing address:
  • Phone: 301-565-4283
  • Fax: 301-244-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: