Organization
IMANI HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH MARIE WILSON LPC, ED.D,CADC, NCC (PROFESSIONAL COUNSELOR)
(706) 825-8472
Entity
Organization
Contact information
Practice address
1227 AUGUSTA WEST PKWY STE 8, AUGUSTA, GA 30909-6671
(706) 825-9051
(706) 860-1850
Mailing address
1227 AUGUSTA WEST PKWY STE 8, AUGUSTA, GA 30909-6671
(706) 825-9051
(706) 860-1850
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
18226
TX
251S00000X
Community/Behavioral Health Agency
Primary
LPC004458
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172613501
—
TX
05
—
184952006A
—
GA
Enumeration date
05/05/2009
Last updated
05/05/2009
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