Individual
MARY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11578 HIGHWAY 27, SUMMERVILLE, GA 30747-5873
(706) 857-5441
(706) 857-7607
Mailing address
PO BOX 308, CARTERSVILLE, GA 30120-0308
(770) 880-2185
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
003040
GA
Other
Enumeration date
05/08/2019
Last updated
05/08/2019
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