Individual
MR. KENNETH LAMAR WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2245 VINEVILLE AVE STE B, MACON, GA 31204-3115
(478) 288-0709
Mailing address
1360 IRWINTON RD APT 6, MILLEDGEVILLE, GA 31061-3886
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
APC006444
GA
101YP2500X
Professional Counselor
Primary
LPC012032
GA
Other
Enumeration date
10/06/2018
Last updated
03/12/2022
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