Individual
ANGELA BYRD WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCAC II
Contact information
Practice address
5680 FULTON INDUSTRIAL BLVD SW, ATLANTA, GA 30336-2659
(404) 484-9640
Mailing address
7263 BLUESTONE DR, RIVERDALE, GA 30296-1513
(404) 484-9640
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87881
GA
172V00000X
Community Health Worker
—
—
Other
Enumeration date
01/13/2025
Last updated
01/13/2025
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