Healthcare Provider Details

I. General information

NPI: 1124954193
Provider Name (Legal Business Name): PHELECIA WILCOXSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 PEACHTREE ST NE STE 100&200
ATLANTA GA
30308-2177
US

IV. Provider business mailing address

827 TRAMORE DR
STOCKBRIDGE GA
30281-6477
US

V. Phone/Fax

Practice location:
  • Phone: 404-951-3534
  • Fax:
Mailing address:
  • Phone: 404-951-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC016178
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: