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1104223999
KEN WILSON
AUGUSTA, GA
NPI
1104223999
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: GA 564)
Enumeration Date
2014-11-24
Last Update Date
2014-11-24
Business Address
Mr. KEN WILSON
2610 COMMONS BLVD
AUGUSTA, GA 30909-2080
Phone number: 706-733-1935
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Mailing Address
Mr. KEN WILSON
2610 COMMONS BLVD
AUGUSTA, GA 30909-2080
Phone number: 706-733-1935
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