Provider Demographics
NPI:1043259344
Name:WILT, NANCY B (LPCC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:B
Last Name:WILT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6449 WILSON MILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143
Mailing Address - Country:US
Mailing Address - Phone:440-442-8800
Mailing Address - Fax:440-442-8804
Practice Address - Street 1:6449 WILSON MILLS ROAD
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:440-442-8800
Practice Address - Fax:440-442-8804
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003423101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional