Individual
CONSUELA TANGULIA WILDS-LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC, NCC
Contact information
Practice address
823 BROAD ST FL 1, AUGUSTA, GA 30901-1214
(706) 770-4257
(706) 925-9855
Mailing address
3800 BLUE SPRINGS TRCE, EVANS, GA 30809-7246
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC010923
GA
101YM0800X
Mental Health Counselor
LPC10860
SC
101YP2500X
Professional Counselor
Primary
LPC010923
GA
101YP2500X
Professional Counselor
LPC10860
SC
251S00000X
Community/Behavioral Health Agency
005087
GA
Other
Enumeration date
11/16/2017
Last updated
08/15/2025
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