Provider Demographics
NPI:1033841465
Name:WILSON, AFIYA KASHAWN (BASW, TCADC)
Entity type:Individual
Prefix:MS
First Name:AFIYA
Middle Name:KASHAWN
Last Name:WILSON
Suffix:
Gender:F
Credentials:BASW, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1366
Mailing Address - Country:US
Mailing Address - Phone:859-492-9883
Mailing Address - Fax:
Practice Address - Street 1:723 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1063
Practice Address - Country:US
Practice Address - Phone:270-600-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277088101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)