Healthcare Provider Details

I. General information

NPI: 1164926952
Provider Name (Legal Business Name): HEATHER NICOLE WILSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S ERIE HWY
HAMILTON OH
45011-4315
US

IV. Provider business mailing address

1910 FAIRGROVE AVE STE E
HAMILTON OH
45011-1930
US

V. Phone/Fax

Practice location:
  • Phone: 513-494-4679
  • Fax:
Mailing address:
  • Phone: 513-494-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2505291
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: