Healthcare Provider Details

I. General information

NPI: 1043259344
Provider Name (Legal Business Name): NANCY B WILT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6449 WILSON MILLS ROAD
MAYFIELD VILLAGE OH
44143
US

IV. Provider business mailing address

6449 WILSON MILLS ROAD
MAYFIELD VILLAGE OH
44143
US

V. Phone/Fax

Practice location:
  • Phone: 440-442-8800
  • Fax: 440-442-8804
Mailing address:
  • Phone: 440-442-8800
  • Fax: 440-442-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0003423
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: