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General NPI Number Information
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NPI Number | 1982093241
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Entity Type | Organization
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Legal Business Name | TYLER WILKINSON PHD LPC
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 3495 PIEDMONT RD NE SUITE 708
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City | ATLANTA
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State | GA
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Zip | 30305-1717
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Country | US
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Telephone | 470-210-7797
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Fax |
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Provider Business Mailing Address
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Address Line | 2659 PATRICK CT SE
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City | ATLANTA
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State | GA
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Zip | 30317-3024
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Country | US
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Telephone | 334-498-2289
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROBERT TYLER WILKINSON
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Credential | PH.D., LPC, ACS, NCC
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Telephone | 334-498-2289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 008029
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License Number State | GA
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