Provider Demographics
NPI:1184173676
Name:WILKINSON, VANESSA (LPC, NCC, DCC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:LPC, NCC, DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N HIGHLAND AVE NE
Mailing Address - Street 2:STE 230-207
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1936
Mailing Address - Country:US
Mailing Address - Phone:678-876-4690
Mailing Address - Fax:877-804-7694
Practice Address - Street 1:245 N HIGHLAND AVE NE
Practice Address - Street 2:STE 230-207
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1936
Practice Address - Country:US
Practice Address - Phone:678-876-4690
Practice Address - Fax:877-804-7694
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3513-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional