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General NPI Number Information
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NPI Number | 1659400646
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Entity Type | Individual
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Provider Name | THOMAS L WILSON LPC
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 1000 COMMISSIONER DR
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City | DARIEN
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State | GA
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Zip | 31305-9487
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Country | US
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Telephone | 912-368-3502
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GREAT OAK TRL
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City | SAVANNAH
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State | GA
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Zip | 31419-9289
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Country | US
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Telephone | 912-443-9515
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC004162
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License Number State | GA
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