| Doctor Name: | MRS. NISHA GANDHI WILSON |
| NPI Number: | 1063737955 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | LPC005489 |
| Business Practice Address: | 114 E Hall St Thomson, GA - 308242726 |
| Business Phone Number: | 7065971777 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1113, THOMSON |
| State: | GA |
| Postal Code: | 308241113 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/02/2010 |
| NPI Last Update Date: | 04/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC005489 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |