Individual
SIMONE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
985 STEEPLECHASE LN, RIVERDALE, GA 30296-2741
(562) 619-6129
Mailing address
985 STEEPLECHASE LN, RIVERDALE, GA 30296-2741
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58-1430183
—
GA
Enumeration date
02/15/2021
Last updated
02/15/2021
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