Healthcare Provider Details

I. General information

NPI: 1396219937
Provider Name (Legal Business Name): SUZANNE ELIZABETH WILKINSON M.A., M.A.R, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 LEHMAN DR STE 201
COLORADO SPRINGS CO
80918-3492
US

IV. Provider business mailing address

145 CAROLINA CLUB DR
GRANDY NC
27939-9633
US

V. Phone/Fax

Practice location:
  • Phone: 719-233-9206
  • Fax:
Mailing address:
  • Phone: 719-233-9206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC.0017775
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0017775
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: