Healthcare Provider Details

I. General information

NPI: 1487012530
Provider Name (Legal Business Name): WISDOM SOLUTIONS OF THE CSRA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 EXECUTIVE CENTER DR SUITE 101
MARTINEZ GA
30907-0951
US

IV. Provider business mailing address

3711 EXECUTIVE CENTER DR SUITE 101
MARTINEZ GA
30907-0951
US

V. Phone/Fax

Practice location:
  • Phone: 706-592-8424
  • Fax: 706-269-2966
Mailing address:
  • Phone: 706-592-8424
  • Fax: 706-269-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCSW005228
License Number StateGA

VIII. Authorized Official

Name: TAMARA AUGUSTIN NOEL
Title or Position: CEO/CLINICAL DIRECTOR
Credential: LCSW
Phone: 706-592-8424