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NPI Code Detail

MEDICARE: CONSUELA TANGULIA WILDS-LEWIS MS, LPC, NCC

MEDICARE: CONSUELA TANGULIA WILDS-LEWIS MS, LPC, NCC
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
1101YM0800XMental Health CounselorLPC10860SC
2101YM0800XMental Health CounselorLPC010923GA
3101YP2500XProfessional CounselorLPC10860SC
4251S00000XCommunity/Behavioral Health Agency005087GA
5101YP2500XProfessional CounselorLPC010923GA

General Provider Information

NPI Number : 1942713664
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONSUELA TANGULIA WILDS-LEWIS MS, LPC, NCC
Provider Business Mailing Address
First Line : 3800 BLUE SPRINGS TRCE
Second Line :
City : EVANS
State : GA
Zip : 30809-7246
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 823 BROAD ST FL 1
Second Line :
City : AUGUSTA
State : GA
Zip : 30901-1214
Country : US
Telephone Number : 706-770-4257
Fax Number : 706-925-9855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2017
Last Update Date : 08/15/2025

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