Provider Demographics
NPI:1437957404
Name:WILSON, MAUREEN DUNN (APC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:DUNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-5623
Mailing Address - Country:US
Mailing Address - Phone:706-913-0340
Mailing Address - Fax:
Practice Address - Street 1:50 PECAN DR NE
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-6670
Practice Address - Country:US
Practice Address - Phone:912-217-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional