Individual
MRS. DONNA WILSON-FANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
341 PONCE DE LEON AVE NE, ATLANTA, GA 30308-2012
(404) 616-6614
(404) 616-9790
Mailing address
238 BRIDGE GRV, DOUGLASVILLE, GA 30134-5455
(770) 709-1546
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CSW004421
GA
Other
Enumeration date
08/08/2011
Last updated
08/08/2011
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