Healthcare Provider Details

I. General information

NPI: 1295333557
Provider Name (Legal Business Name): MEGHAN E WILSON MS, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 E MAIN ST
COLUMBUS OH
43213-3298
US

IV. Provider business mailing address

2769 DONNA DR
COLUMBUS OH
43220-4506
US

V. Phone/Fax

Practice location:
  • Phone: 614-875-2371
  • Fax:
Mailing address:
  • Phone: 920-636-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2203258
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2002999
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2203258-SUPV
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: