Provider Demographics
NPI:1588861991
Name:WILSON, TASHYA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TASHYA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TASHYA
Other - Middle Name:
Other - Last Name:EKECHUKWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 37215
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3215
Mailing Address - Country:US
Mailing Address - Phone:301-565-4283
Mailing Address - Fax:301-244-6301
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:301-565-4283
Practice Address - Fax:301-244-6301
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8024Medicare ID - Type Unspecified