Provider Demographics
NPI:1134286743
Name:WILSON, KATHLEEN C (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:C
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-4460
Mailing Address - Country:US
Mailing Address - Phone:412-292-8439
Mailing Address - Fax:412-939-0246
Practice Address - Street 1:4721 MCKNIGHT RD
Practice Address - Street 2:SUITE 218 SOUTH
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3415
Practice Address - Country:US
Practice Address - Phone:412-369-4285
Practice Address - Fax:412-939-0246
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional