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General NPI Number Information
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NPI Number | 1407401557
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Entity Type | Individual
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Provider Name | MUSA AKIL WILSON CDCA 170892
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Gender | Male
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 11134 LUSCHEK DR
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City | BLUE ASH
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State | OH
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Zip | 45241-2434
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Country | US
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Telephone | 513-827-9273
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Fax |
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Provider Business Mailing Address
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Address Line | 3740 IONA AVE
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City | CINCINNATI
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State | OH
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Zip | 45213-1908
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Country | US
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Telephone | 513-917-9731
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CDCA.170892
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License Number State | OH
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