MEDICARE: WIL TO WELLNESS

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497610059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WIL TO WELLNESS

Provider Business Mailing Address
First Line	:	100 WALNUT AVE
Second Line	:
City	:	CLARK
State	:	NJ
Zip	:	07066-1253
Country	:	US
Telephone Number	:	917-722-1266
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WALNUT AVE
Second Line	:
City	:	CLARK
State	:	NJ
Zip	:	07066-1253
Country	:	US
Telephone Number	:	917-722-1266
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	WILANDA NICOLAS
Credential	:	LPC
Telephone Number	:	917-722-1266

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	04/14/2026

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Directions to “WIL TO WELLNESS ” Practice Location

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