MEDICARE: DR. SHANIKA LAVI WILSON DSW, LCAS, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	2795	NC
2	1041C0700X	Clinical Social Worker	Q5-0000350	DE
3	1041C0700X	Clinical Social Worker	C006604	NC
4	1041C0700X	Clinical Social Worker	1880	SC

General Provider Information

NPI Number	:	1619096393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANIKA LAVI WILSON DSW, LCAS, LCSW

Provider Business Mailing Address
First Line	:	9600 TWO NOTCH RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-4304
Country	:	US
Telephone Number	:	803-310-2774
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 TWO NOTCH RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-4304
Country	:	US
Telephone Number	:	803-310-2774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	06/04/2026

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