Provider Demographics
NPI:1962139998
Name:MOULIS, WENDE ADAMS (CAC LL)
Entity type:Individual
Prefix:MS
First Name:WENDE
Middle Name:ADAMS
Last Name:MOULIS
Suffix:
Gender:F
Credentials:CAC LL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MALL BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4862
Mailing Address - Country:US
Mailing Address - Phone:912-515-5026
Mailing Address - Fax:912-785-2008
Practice Address - Street 1:401 MALL BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4862
Practice Address - Country:US
Practice Address - Phone:912-515-5026
Practice Address - Fax:912-785-2008
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3411101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty