Provider Demographics
NPI:1588174296
Name:WILSON, TRENECSIA KA-SHONNE (LMHC, MHP, CDPT, NCC)
Entity type:Individual
Prefix:
First Name:TRENECSIA
Middle Name:KA-SHONNE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMHC, MHP, CDPT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30412 3RD PL S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4006
Mailing Address - Country:US
Mailing Address - Phone:253-268-6034
Mailing Address - Fax:
Practice Address - Street 1:130 ANDOVER PARK E
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2909
Practice Address - Country:US
Practice Address - Phone:253-268-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-08
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60671389101YA0400X
WALH61042465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)