Provider Demographics
NPI:1518372812
Name:TONYIA WILSON
Entity Type:Organization
Organization Name:TONYIA WILSON
Other - Org Name:MERRIHEART COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:229-548-8591
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:GA
Mailing Address - Zip Code:31647-0142
Mailing Address - Country:US
Mailing Address - Phone:229-548-8591
Mailing Address - Fax:229-549-7906
Practice Address - Street 1:101 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2632
Practice Address - Country:US
Practice Address - Phone:229-548-8591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007793302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization