Provider Demographics
NPI:1477092724
Name:WILSON, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WILSON
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 1:2073 SINGER WAY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5479
Mailing Address - Country:US
Mailing Address - Phone:470-216-4473
Mailing Address - Fax:
Practice Address - Street 1:3547 HABERSHAM AT NORTHLAKE
Practice Address - Street 2:BUILDING F
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4001
Practice Address - Country:US
Practice Address - Phone:678-406-9707
Practice Address - Fax:678-406-9881
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor