Provider Demographics
NPI:1093314478
Name:WILSON, KALYN DANIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:KALYN
Middle Name:DANIELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 CHAMBLEE TUCKER RD UNIT 941655
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31141-5029
Mailing Address - Country:US
Mailing Address - Phone:678-957-7691
Mailing Address - Fax:
Practice Address - Street 1:5193 PEACHTREE BLVD APT 3405
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-2867
Practice Address - Country:US
Practice Address - Phone:678-313-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0082781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical