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NPI Code Detail

MEDICARE: MRS. JACQUELIN D WILSON LPC

MEDICARE: MRS. JACQUELIN D WILSON LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC008703GA

General Provider Information

NPI Number : 1437505021
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACQUELIN D WILSON LPC
Provider Business Mailing Address
First Line : 717 NORTH AVENUE
Second Line :
City : MACON
State : GA
Zip : 31211-1418
Country : US
Telephone Number : 478-475-4608
Fax Number : 478-476-8397
Provider Business Practice Location Address
First Line : 144 PIERCE AVE
Second Line :
City : MACON
State : GA
Zip : 31204-2860
Country : US
Telephone Number : 478-475-4608
Fax Number : 478-476-8397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2016
Last Update Date : 05/06/2026

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