Provider Demographics
NPI:1306693999
Name:WILSON, JA'NICIA I (MSW)
Entity type:Individual
Prefix:MISS
First Name:JA'NICIA
Middle Name:I
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 COLUMBIA RD STE 13B
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0445
Mailing Address - Country:US
Mailing Address - Phone:706-496-2856
Mailing Address - Fax:762-333-2872
Practice Address - Street 1:4210 COLUMBIA RD STE 13B
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0445
Practice Address - Country:US
Practice Address - Phone:706-496-2856
Practice Address - Fax:762-333-2872
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker