| Doctor Name: | ANGELA K. WILSON |
| NPI Number: | 1093051351 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | LPC005354 |
| Business Practice Address: | 300 Broadway Ave Post Office Box 637 Braselton, GA - 30517 |
| Business Phone Number: | 7064479050 |
| Business Fax Number: | |
| Mailing Address: | Po Box 637, 300 Broadway Avenue BRASELTON |
| State: | GA |
| Postal Code: | 305170011 |
| Phone Number: | 7064479050 |
| Fax Number: | |
| NPI Enumeration Date: | 12/13/2012 |
| NPI Last Update Date: | 08/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC005354 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |