Individual
MONIQUE YVETTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
139 HENRY PKWY, MCDONOUGH, GA 30253-6636
(770) 358-5252
Mailing address
1435 N EXPRESSWAY STE 301, GRIFFIN, GA 30223-9014
(770) 358-5252
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
002017
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58-2098758
—
GA
Enumeration date
06/11/2021
Last updated
06/11/2021
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