Provider Demographics
NPI:1952295768
Name:WILEY, CHRISTOPHER LASHUN II
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LASHUN
Last Name:WILEY
Suffix:II
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HERITAGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3047
Mailing Address - Country:US
Mailing Address - Phone:313-926-9820
Mailing Address - Fax:
Practice Address - Street 1:1 HERITAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3047
Practice Address - Country:US
Practice Address - Phone:313-926-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician