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General NPI Number Information
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NPI Number | 1942713664
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Entity Type | Individual
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Provider Name | CONSUELA TANGULIA WILDS-LEWIS MS, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 823 BROAD ST FL 1
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City | AUGUSTA
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State | GA
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Zip | 30901-1214
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Country | US
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Telephone | 706-770-4257
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Fax | 706-925-9855
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Provider Business Mailing Address
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Address Line | 3800 BLUE SPRINGS TRCE
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City | EVANS
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State | GA
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Zip | 30809-7246
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Country | US
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Telephone |
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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 | LPC10860
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC010923
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC10860
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 005087
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC010923
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License Number State | GA
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