Provider Demographics
NPI:1164926952
Name:WILSON, HEATHER NICOLE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 HARVEY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2685
Mailing Address - Country:US
Mailing Address - Phone:614-253-3910
Mailing Address - Fax:614-253-3962
Practice Address - Street 1:900 HARVEY CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2685
Practice Address - Country:US
Practice Address - Phone:614-253-3910
Practice Address - Fax:614-253-3962
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1600830101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional