Healthcare Provider Details

I. General information

NPI: 1134286743
Provider Name (Legal Business Name): KATHLEEN C WILSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 MCKNIGHT RD SUITE 218 SOUTH
PITTSBURGH PA
15237-3415
US

IV. Provider business mailing address

548 TYLER ST
PITTSBURGH PA
15237-4460
US

V. Phone/Fax

Practice location:
  • Phone: 412-369-4285
  • Fax: 412-939-0246
Mailing address:
  • Phone: 412-292-8439
  • Fax: 412-939-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC002763
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: