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General NPI Number Information
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NPI Number | 1053106633
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Entity Type | Organization
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Legal Business Name | DWILSON COUNSELING, PLLC
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 640 PIERCE BLVD STE 200
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City | O FALLON
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State | IL
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Zip | 62269-2584
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Country | US
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Telephone | 618-406-2490
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Fax |
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Provider Business Mailing Address
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Address Line | 2126 VILLAGE PKWY
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City | SAN ANTONIO
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State | TX
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Zip | 78251-2611
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Country | US
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Telephone | 317-900-6556
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOMINIQUE WILSON
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Credential |
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Telephone | 618-406-2490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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