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NPI Code Detail

MEDICARE: ALICIA ANN WILSON-THOMAS NCC, LCPC

MEDICARE: ALICIA ANN WILSON-THOMAS NCC, LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor180014048IL

General Provider Information

NPI Number : 1053961524
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA ANN WILSON-THOMAS NCC, LCPC
Provider Business Mailing Address
First Line : 6709 S LANGLEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60637-4136
Country : US
Telephone Number : 773-368-6153
Fax Number :
Provider Business Practice Location Address
First Line : 25 E WASHINGTON ST STE 1835
Second Line :
City : CHICAGO
State : IL
Zip : 60602-1836
Country : US
Telephone Number : 312-940-3655
Fax Number : 312-374-4966
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2019
Last Update Date : 11/20/2023

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