Individual
BREANA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5331 NATHAN DR NW, LILBURN, GA 30047-5858
(832) 878-3092
Mailing address
3655 HOWELL FERRY RD, DULUTH, GA 30096-3186
(770) 373-5822
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
37508817
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37508817
—
TX
Enumeration date
01/17/2019
Last updated
01/07/2022
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