Healthcare Provider Details

I. General information

NPI: 1518473438
Provider Name (Legal Business Name): SHERRI KAY WILSON LPC, CRC,CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 HOOVER RD
GROVE CITY OH
43123-9122
US

IV. Provider business mailing address

4799 OAKWAY DR
COLUMBUS OH
43228-3316
US

V. Phone/Fax

Practice location:
  • Phone: 740-577-8833
  • Fax:
Mailing address:
  • Phone: 740-577-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number080493
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00218525
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: