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JACQUELINE HOLLEY WILSON
NPI 1740846039
Social Worker - Clinical in Buford, GA

Active since May 13, 2019Opted out of Medicare · through Jan 16, 2028
4305 S LEE ST STE 500, BUFORD, GA 30518(678) 602-9229(770) 995-1959 Get Directions Write a Review

NPPES record last updated: October 17, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 17, 2023, Oct 28, 2022, Oct 6, 2022 and 2 more (5 updates tracked since 2019).

About Jacqueline Holley Wilson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACQUELINE HOLLEY WILSON (NPI 1740846039) is an individual clinical provider in Buford, Georgia and active in the NPI registry since May 2019. She has opted out of Medicare through January 16, 2028.

NPPES Registry Identity

NPI1740846039
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameJACQUELINE HOLLEY WILSON
Location Address4305 S LEE ST STE 500Buford, GA 30518-5785
Mailing Address3644 Buttercup CtBuford, GA 30519-1983 · (678) 602-9229 · Fax (770) 995-1959
Phone(678) 602-9229
Fax(770) 995-1959
Sole ProprietorNo
Enumeration DateMay 13, 2019
Last NPPES UpdateOctober 17, 20235 updates tracked since enumeration
NPPES CertifiedOctober 17, 2023
✔ NPI 1740846039 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
4305 S LEE ST STE 500, Buford, GA 30518
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Jacqueline Holley Wilson has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 16, 2024 through January 16, 2028.

Opt-Out Effective DateJanuary 16, 2024
Opt-Out In Effect ThroughJanuary 16, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

INSIGHT COUNSELING AND COACHING
Counselor (Professional)
4305 S LEE ST STE 500
BUFORD, GA 30518
Gwinnett County (678) 779-9314
APRIL KUNIS M.A., L.P.C
Counselor (Professional)
4305 S LEE ST STE 500
BUFORD, GA 30518
Gwinnett County (678) 779-9314
IVIE HALL LPC
Counselor (Professional)
4305 S LEE ST STE 500
BUFORD, GA 30518
Gwinnett County (404) 590-7325
MRS. JAMALYN YATES LPC
Counselor (Professional)
4305 S LEE ST STE 500
BUFORD, GA 30518
Gwinnett County (770) 339-7667

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacqueline Wilson's NPI number?

The NPI number for Jacqueline Wilson is 1740846039. It was assigned to this individual provider in the NPPES registry on May 13, 2019.

Where is Jacqueline Wilson located?

Jacqueline Wilson practices at 4305 S Lee St Ste 500, Buford, GA 30518. The listed phone number is (678) 602-9229.

What is Jacqueline Wilson's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Jacqueline Wilson enrolled in Medicare?

No. Jacqueline Wilson has opted out of Medicare through January 16, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jacqueline Wilson was last updated on October 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.