Healthcare Provider Details

I. General information

NPI: 1982093241
Provider Name (Legal Business Name): TYLER WILKINSON PHD LPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 PIEDMONT RD NE SUITE 708
ATLANTA GA
30305-1717
US

IV. Provider business mailing address

2659 PATRICK CT SE
ATLANTA GA
30317-3024
US

V. Phone/Fax

Practice location:
  • Phone: 470-210-7797
  • Fax:
Mailing address:
  • Phone: 334-498-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number008029
License Number StateGA

VIII. Authorized Official

Name: DR. ROBERT TYLER WILKINSON
Title or Position: DIRECTOR
Credential: PH.D., LPC, ACS, NCC
Phone: 334-498-2289