Healthcare Provider Details

I. General information

NPI: 1124792833
Provider Name (Legal Business Name): NLC CONSULTING SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 S BROADWAY STE 121
LEXINGTON KY
40508-2955
US

IV. Provider business mailing address

PO BOX 11851
LEXINGTON KY
40578-1851
US

V. Phone/Fax

Practice location:
  • Phone: 859-317-9558
  • Fax: 859-406-1066
Mailing address:
  • Phone: 859-317-9558
  • Fax: 859-406-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. DOMINIQUE LASHAN WILSON
Title or Position: OWNER
Credential: LPCC-S, MAC, CCCE
Phone: 859-312-3744