Provider Demographics
NPI:1801515960
Name:WILSON, JENNIFER DENETTE (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENETTE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 ROSEBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-5612
Mailing Address - Country:US
Mailing Address - Phone:912-658-5806
Mailing Address - Fax:
Practice Address - Street 1:6555 ABERCORN ST STE 221
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5714
Practice Address - Country:US
Practice Address - Phone:912-200-9818
Practice Address - Fax:912-200-9819
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional