Provider Demographics
NPI:1588965446
Name:WILES, ANN KIMBALL (LPC)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:KIMBALL
Last Name:WILES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 JULIA DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4394
Mailing Address - Country:US
Mailing Address - Phone:770-800-9700
Mailing Address - Fax:
Practice Address - Street 1:366 JULIA DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-4394
Practice Address - Country:US
Practice Address - Phone:770-800-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional