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General NPI Number Information
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NPI Number | 1053961524
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Entity Type | Individual
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Provider Name | ALICIA ANN WILSON-THOMAS NCC, LCPC
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Gender | Female
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST STE 1835
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City | CHICAGO
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State | IL
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Zip | 60602-1836
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Country | US
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Telephone | 312-940-3655
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Fax | 312-374-4966
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Provider Business Mailing Address
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Address Line | 6709 S LANGLEY AVE
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City | CHICAGO
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State | IL
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Zip | 60637-4136
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Country | US
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Telephone | 773-368-6153
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180014048
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License Number State | IL
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