Shatisha Matrice Wilson, MS, LPC, RPT-S, ACS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC008626 Issued in GA

Practice address

4210 Columbia Rd Ste 13B
Martinez, GA 30907-0445

Phone

(706) 496-2856

Fax

(762) 333-2872

NPI assigned

Jul 2, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wilson'S Garden of Hope

  • Professional Counselor
  • Augusta, GA
  • NPI 1710325766
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1073953253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3134",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308090079",
            "telephone_number": "706-496-2856",
            "fax_number": "762-333-2872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4210 COLUMBIA RD STE 13B",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309070445",
            "telephone_number": "706-496-2856",
            "fax_number": "762-333-2872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SHATISHA",
        "middle_name": "MATRICE",
        "credential": "MS, LPC, RPT-S, ACS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-02",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "PC8041",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC008626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlesetta Willis, MHA, MS, RN
• Ronald Willis, MFT, BA
• Adrienne S Wilson, LPC
• Ja'Nicia I. Wilson, MSW
• John Wilson Sr.
• Steven Lamar Wilson, D.M.D.
• Wisdom Solutions of the Csra, LLC
• Katherine Wise
• Hannah Wiseman, COTA
• WM Dental Group LLC

• Professional Counselor in Martinez, GA
• Providers in Martinez, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.