person
Ebony Wilson
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Saint Louis, Missouri
NPI 1013334622

Ebony Wilson is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Saint Louis, MO. Ebony Wilson practices in Saint Louis, MO. The NPI Number for Ebony Wilson is 1013334622 and holds a License No. (Missouri).

The current practice location address for Ebony Wilson is 3514 Blair Ave, Saint Louis, MO and can be reached out via phone at 314-216-0088.

Location: 3514 Blair Ave, Saint Louis, MO, 63115-0654
person
Provider Profile Details
NPI Number
1013334622
Provider Name
Ebony Wilson
Credential
Provider Entity Type
Individual
Gender
Female
Address
3514 Blair Ave, Saint Louis, MO, 63115-0654
Phone Number
314-216-0088
Fax Number
Provider Enumeration Date
03/20/2014
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
3514 Blair Ave
City
State
Zip
63107-3717
Phone Number
314-216-0088
Fax Number
person
Provider Business Mailing Address Details
Address
3514 Blair Ave
City
State
Zip
63107-3717
Phone Number
314-216-0088
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
License No.
()
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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