| Doctor Name: | TRACY C WILSON |
| NPI Number: | 1033256938 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.ED. |
| License Number: | 2748 |
| Business Practice Address: | 215 Bradley St Carrollton, GA - 301173217 |
| Business Phone Number: | 7708329140 |
| Business Fax Number: | 7708323046 |
| Mailing Address: | 215 Bradley St, CARROLLTON |
| State: | GA |
| Postal Code: | 301173217 |
| Phone Number: | 7708329140 |
| Fax Number: | 7708323046 |
| NPI Enumeration Date: | 01/31/2007 |
| NPI Last Update Date: | 11/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2748 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |