Individual
MRS. JACQUELIN D WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
144 PIERCE AVE, MACON, GA 31204-2860
(478) 475-4608
(478) 476-8397
Mailing address
717 NORTH AVENUE, MACON, GA 31211-1418
(478) 475-4608
(478) 476-8397
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC008703
GA
Other
Enumeration date
05/12/2016
Last updated
05/06/2026
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