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General NPI Number Information
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NPI Number | 1528720794
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Entity Type | Individual
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Provider Name | FELICIA LASHAWN WILSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 9818 FOREST HILL DR
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7630
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Country | US
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Telephone | 678-386-3714
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6123
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City | DOUGLASVILLE
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State | GA
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Zip | 30154-0019
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Country | US
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Telephone | 678-386-3714
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW008673
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW002777
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License Number State | GA
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