Provider Demographics
NPI:1275070658
Name:WILSON, BRITTANY ALEXIS (MA, LPCC-S, NCC)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:ALEXIS
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LPCC-S, NCC
Other - Prefix:MISS
Other - First Name:BRITTANY
Other - Middle Name:ALEXIS
Other - Last Name:WILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, NCC
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-0802
Mailing Address - Country:US
Mailing Address - Phone:859-428-7862
Mailing Address - Fax:859-999-7869
Practice Address - Street 1:451 BIG HILL AVE STE 5
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2596
Practice Address - Country:US
Practice Address - Phone:859-428-7862
Practice Address - Fax:859-999-7869
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246485101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100606820Medicaid