Provider Demographics
NPI:1033732946
Name:WILSON, CORLISSA J (EDD, LPC, NCC, NCSC)
Entity Type:Individual
Prefix:DR
First Name:CORLISSA
Middle Name:J
Last Name:WILSON
Suffix:
Gender:F
Credentials:EDD, LPC, NCC, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 WARREN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-9044
Mailing Address - Country:US
Mailing Address - Phone:404-435-3388
Mailing Address - Fax:
Practice Address - Street 1:3217 WARREN CREEK DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-9044
Practice Address - Country:US
Practice Address - Phone:404-435-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health