Individual
KIMBERLY MOSS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CAADC
Contact information
Practice address
1116 E PONCE DE LEON AVE, DECATUR, GA 30030-2711
(404) 377-7669
(404) 377-8536
Mailing address
3921 KENSINGTON DR, MARIETTA, GA 30066-2535
(404) 936-1431
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C0159
GA
1041C0700X
Clinical Social Worker
Primary
CSW005573
GA
Other
Enumeration date
03/03/2016
Last updated
06/24/2016
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