Individual
MRS. KENYATTA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
500 OLD BREMEN RD, SUITE 101, CARROLLTON, GA 30117-5216
(770) 820-3070
Mailing address
815 BANKHEAD HWY STE G, CARROLLTON, GA 30117-1970
(770) 820-3070
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC007401
GA
101YP2500X
Professional Counselor
LPC007401
GA
Other
Enumeration date
01/28/2008
Last updated
12/29/2021
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