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General NPI Number Information
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NPI Number | 1255659421
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Entity Type | Individual
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Provider Name | LISA WILMOT LPC
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Gender | Female
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 26850 PROVIDENCE PKWY
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City | NOVI
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State | MI
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Zip | 48374-1213
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Country | US
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Telephone | 248-465-4335
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Fax | 248-465-4535
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Provider Business Mailing Address
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Address Line | 8629 KALAMAZOO RIVER DR
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City | FOWLERVILLE
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State | MI
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Zip | 48836-9059
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Country | US
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Telephone | 248-465-4335
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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 | 6401011483
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License Number State | MI
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