Crystal Marie Wilson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW006581 Issued in GA

Practice address

22C E Newnan Rd
Newnan, GA 30263-2230

Phone

(803) 616-4095

NPI assigned

Dec 26, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Southeast Perinatal Counseling LLC

  • Clinical Social Worker
  • Newnan, GA
  • NPI 1376150870
  NPD Authorized official

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

{
    "created_epoch": "1545782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1598237885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 NEWNAN CROSSING BLVD E APT 4213",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302650010",
            "telephone_number": "803-616-4095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22C E NEWNAN RD",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302632230",
            "telephone_number": "803-616-4095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CRYSTAL",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-26",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW006581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shameka Doniedre Williamson
• Willow Counseling & Wellness, LLC
• Willow Oak Community Behavioral Health Center
• Willow Oak Foundation, Inc.
• Caylee Louise Wilson
• Sandra Wilson
• Brittany Wilt, MOTR/L
• Clarice Annette Wimberly, MD, MS
• Stephen Wingo
• Albert Jacob Wisenauer, PTA

• Clinical Social Worker in Newnan, GA
• Providers in Newnan, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.