Provider Demographics
NPI:1710315916
Name:WILSON-WOODS, DORELLA
Entity Type:Individual
Prefix:MRS
First Name:DORELLA
Middle Name:
Last Name:WILSON-WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SOUTHERN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-9447
Mailing Address - Country:US
Mailing Address - Phone:770-401-7041
Mailing Address - Fax:
Practice Address - Street 1:54 SOUTHERN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-9447
Practice Address - Country:US
Practice Address - Phone:770-401-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker