Individual
MR. KEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2610 COMMONS BLVD, AUGUSTA, GA 30909-2080
(706) 733-1935
(706) 667-8727
Mailing address
2610 COMMONS BLVD, AUGUSTA, GA 30909-2080
(706) 733-1935
(706) 667-8727
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
564
GA
Other
Enumeration date
11/24/2014
Last updated
11/24/2014
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