Provider Demographics
NPI:1427518778
Name:WILSON, KRYSTYNA WIKTORIA (MS)
Entity type:Individual
Prefix:MRS
First Name:KRYSTYNA
Middle Name:WIKTORIA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 GALAHAD DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3632
Mailing Address - Country:US
Mailing Address - Phone:404-518-0102
Mailing Address - Fax:
Practice Address - Street 1:1780 CENTURY BLVD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3399
Practice Address - Country:US
Practice Address - Phone:404-636-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty