Provider Demographics
NPI:1629442967
Name:WILSON, KATHERINE ALBICKER (LPC,)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALBICKER
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 1:4402 HEIDI PLACE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112
Mailing Address - Country:US
Mailing Address - Phone:804-363-2583
Mailing Address - Fax:804-510-0244
Practice Address - Street 1:8527 MAYLAND DR
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4753
Practice Address - Country:US
Practice Address - Phone:804-363-2583
Practice Address - Fax:804-510-0244
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional