| Doctor Name: | DR. TRINA RENEE' WILSON |
| NPI Number: | 1548378631 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD, M.DIV, LCSW |
| License Number: | 1764 |
| Business Practice Address: | 617 Roswell St Ne Marietta, GA - 300603502 |
| Business Phone Number: | 4049316535 |
| Business Fax Number: | 7704208101 |
| Mailing Address: | 5955 Tibor Dr Nw, ACWORTH |
| State: | GA |
| Postal Code: | 301016949 |
| Phone Number: | 4049316535 |
| Fax Number: | 7704208101 |
| NPI Enumeration Date: | 08/28/2006 |
| NPI Last Update Date: | 02/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 1764 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |