Provider Demographics
NPI:1538487087
Name:WILSON-REESE, CARMEN NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:NICOLE
Last Name:WILSON-REESE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 JULE INGRAM RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 PEACHTREE ST NW
Practice Address - Street 2:SUITE 770
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2316
Practice Address - Country:US
Practice Address - Phone:478-445-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002035103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical