Provider Demographics
NPI:1881401685
Name:ESPINAL PERALTA, WILSON
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:ESPINAL PERALTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CHAUCER PKWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7150
Mailing Address - Country:US
Mailing Address - Phone:347-299-7540
Mailing Address - Fax:
Practice Address - Street 1:185 CHAUCER PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7150
Practice Address - Country:US
Practice Address - Phone:347-299-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral