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General NPI Number Information
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NPI Number | 1487012530
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Entity Type | Organization
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Legal Business Name | WISDOM SOLUTIONS OF THE CSRA, LLC
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 3711 EXECUTIVE CENTER DR SUITE 101
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City | MARTINEZ
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State | GA
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Zip | 30907-0951
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Country | US
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Telephone | 706-592-8424
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Fax | 706-269-2966
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Provider Business Mailing Address
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Address Line | 3711 EXECUTIVE CENTER DR SUITE 101
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City | MARTINEZ
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State | GA
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Zip | 30907-0951
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Country | US
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Telephone | 706-592-8424
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Fax | 706-269-2966
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Authorized Official
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Title or Position | CEO/CLINICAL DIRECTOR
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Name | TAMARA AUGUSTIN NOEL
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Credential | LCSW
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Telephone | 706-592-8424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSW005228
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License Number State | GA
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