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General NPI Number Information
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NPI Number | 1457201253
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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 | 01/30/2026
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Last Update Date | 01/30/2026
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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 | 8703 WOODS END ST
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City | SAN ANTONIO
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State | TX
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Zip | 78240-3739
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Country | US
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Telephone |
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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 | LCPC
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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