Provider Demographics
NPI:1891465514
Name:WILSON, MARTA NEMETH (LAPC, CADC II)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:NEMETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:LAPC, CADC II
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAPC, CADC II
Mailing Address - Street 1:213 WALL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-4613
Mailing Address - Country:US
Mailing Address - Phone:706-768-2452
Mailing Address - Fax:
Practice Address - Street 1:213 WALL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-4613
Practice Address - Country:US
Practice Address - Phone:706-768-2452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0988101YA0400X
GAAPC007659101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)