Healthcare Provider Details

I. General information

NPI: 1639640048
Provider Name (Legal Business Name): ALIESHA DJANEA WILSON-SKEETE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S SWOOPE AVE STE 211
MAITLAND FL
32751-5786
US

IV. Provider business mailing address

6740 MAGNOLIA POINTE CIR
ORLANDO FL
32810-3536
US

V. Phone/Fax

Practice location:
  • Phone: 407-622-0444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: