Individual
EBONY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
1133 13TH ST, COLUMBUS, GA 31901-2248
(706) 225-0101
(706) 225-0052
Mailing address
1133 13TH ST, COLUMBUS, GA 31901-2248
(706) 225-0101
(706) 225-0052
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-15-05618
GA
Other
Enumeration date
03/20/2018
Last updated
03/20/2018
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