Monique Yvette Wilson, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

002017 Issued in GA

Practice address

139 Henry Pkwy
McDonough, GA 30253-6636

Phone

(770) 358-5252

NPI assigned

Jun 11, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1306414859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1435 N EXPRESSWAY STE 301",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302239014",
            "telephone_number": "770-358-5252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 HENRY PKWY",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536636",
            "telephone_number": "770-358-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MONIQUE",
        "middle_name": "YVETTE",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-11",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "002017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "58-2098758",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "McDonough",
            "affiliation": "N",
            "endpointDescription": "Counseling Center",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "139 Henry Pkwy",
            "city": "McDonough",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302536636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jirah Candice Willis
• Michelle Denise Willis, MA, MA, LGADC, CMAC
• Dominique Willock
• Angelica Nicole Wilson, LPC
• Candi Antoinette Wilson
• Shalunda D Wimes, RN
• Laurie Cook Windham, PHARM.D.
• Winlace Stretch Solutions
• Bibian Carol Wisdom -Johnson, SLP
• Within Reach Counseling and Coaching, LLC

• Social Worker in McDonough, GA
• Providers in McDonough, GA by specialty
• Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; 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.