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General NPI Number Information
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NPI Number | 1124918933
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Entity Type | Individual
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Provider Name | SAMANTHA LEE WILSON LPCC
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Gender | Female
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Dates
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Enumeration Date | 07/04/2025
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Last Update Date | 07/04/2025
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Provider Practice Location Address
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Address Line | 504 N MAIN ST STE B
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1125
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Country | US
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Telephone | 859-707-5368
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Fax | 859-759-0970
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Provider Business Mailing Address
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Address Line | 504 N MAIN ST STE B
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1125
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Country | US
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Telephone | 859-759-1223
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Fax | 859-759-0970
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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 | 297672
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License Number State | KY
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