Provider Demographics
NPI:1235827163
Name:WILSON, QUINNTESSA LASHUN (MSW)
Entity Type:Individual
Prefix:MS
First Name:QUINNTESSA
Middle Name:LASHUN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 N SUMMIT DR UNIT 59
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-0334
Mailing Address - Country:US
Mailing Address - Phone:423-413-0070
Mailing Address - Fax:
Practice Address - Street 1:1897 N SUMMIT DR UNIT 59
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-0334
Practice Address - Country:US
Practice Address - Phone:423-413-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health