Provider Demographics
NPI:1487012530
Name:WISDOM SOLUTIONS OF THE CSRA, LLC
Entity Type:Organization
Organization Name:WISDOM SOLUTIONS OF THE CSRA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:AUGUSTIN
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-592-8424
Mailing Address - Street 1:3711 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0951
Mailing Address - Country:US
Mailing Address - Phone:706-592-8424
Mailing Address - Fax:706-269-2966
Practice Address - Street 1:3711 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0951
Practice Address - Country:US
Practice Address - Phone:706-592-8424
Practice Address - Fax:706-269-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251E00000X
GACSW005228251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003157541AMedicaid
GA003157541AMedicaid