Provider Demographics
NPI:1992699128
Name:WILSON, BLESSY (RBT)
Entity type:Individual
Prefix:
First Name:BLESSY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 SECRETARIAT GAIT WAY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4668
Mailing Address - Country:US
Mailing Address - Phone:678-395-3641
Mailing Address - Fax:
Practice Address - Street 1:1384 BUFORD BUSINESS BLVD # B500
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-9251
Practice Address - Country:US
Practice Address - Phone:706-870-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical