Individual provider · Type 1 NPI
Shamba Wilson
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Chesapeake, VA
Practice location
1332 Gust Ln
Chesapeake, VA 23323-2930
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | None listed |
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | None listed |
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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About NPI 1083402200
Shamba Wilson's National Provider Identifier is 1083402200, issued on Apr 28, 2025. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Chesapeake, VA. The record was last updated on Apr 28, 2025.