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Organization
WILSON'S GARDEN OF HOPE
Active
Organization
WILSON'S GARDEN OF HOPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHATISHA MATRICE WILSON M.S. (EXECUTIVE DIRECTOR)
(762) 233-4642
Entity
Organization
Contact information
Practice address
3062 DAMASCUS RD, SUITE 100, AUGUSTA, GA 30909-4068
(762) 233-4642
Mailing address
3478 ESSEX PL, HEPHZIBAH, GA 30815-7172
(762) 233-4642
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LAPC002949
GA
101YP2500X
Professional Counselor
Primary
LPC006436
GA
Other
Enumeration date
06/12/2013
Last updated
06/12/2013
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