Provider Demographics
NPI:1699550210
Name:WILSON, KATARA NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:KATARA
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 WILDWOOD AVE APT D2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2082
Mailing Address - Country:US
Mailing Address - Phone:229-314-4172
Mailing Address - Fax:
Practice Address - Street 1:1661 13TH ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3844
Practice Address - Country:US
Practice Address - Phone:706-573-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional