Provider Demographics
NPI:1700215787
Name:WILSON, LINDA DENISE (PP/CPS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DENISE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PP/CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 S MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-6370
Mailing Address - Country:US
Mailing Address - Phone:229-336-2247
Mailing Address - Fax:229-336-8009
Practice Address - Street 1:198 S MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-6370
Practice Address - Country:US
Practice Address - Phone:229-336-2247
Practice Address - Fax:229-336-8009
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health