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General NPI Number Information
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NPI Number | 1033841465
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Entity Type | Individual
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Provider Name | AFIYA KASHAWN WILSON BASW, TCADC
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Gender | Female
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Dates
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Enumeration Date | 06/24/2022
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 723 HAWKINS DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-1063
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Country | US
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Telephone | 270-600-0276
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Fax |
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Provider Business Mailing Address
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Address Line | 218 CLIFTON RD
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City | VERSAILLES
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State | KY
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Zip | 40383-1366
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Country | US
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Telephone | 859-492-9883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 277088
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License Number State | KY
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