Provider Demographics
NPI:1073004081
Name:HOWARD, WENDI WILSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDI
Middle Name:WILSON
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 PACES FERRY RD SE STE 202E
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3732
Mailing Address - Country:US
Mailing Address - Phone:770-432-9750
Mailing Address - Fax:770-432-1722
Practice Address - Street 1:2931 PACES FERRY RD SE STE 202E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3732
Practice Address - Country:US
Practice Address - Phone:770-432-9750
Practice Address - Fax:770-432-1722
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist