MEDICARE: THE WILSON CENTER FOR WELL-BEING LLC

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
1	101YP2500X	Professional Counselor	LPC001653	GA

General Provider Information

NPI Number	:	1568829869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WILSON CENTER FOR WELL-BEING LLC

Provider Business Mailing Address
First Line	:	3520 BROOKHILL CIR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-1118
Country	:	US
Telephone Number	:	678-907-5987
Fax Number	:	678-560-2481

Provider Business Practice Location Address
First Line	:	2854 JOHNSON FERRY RD
Second Line	:	SUITE 200
City	:	MARIETTA
State	:	GA
Zip	:	30062-5699
Country	:	US
Telephone Number	:	678-907-5987
Fax Number	:	678-560-2481

Authorized Official
Title or Position	:	OWNER
Name	:	ANN MURPHY WILSON BILLIAN
Credential	:	MS, LPC, CADCII
Telephone Number	:	678-504-6512

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	12/10/2024

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