Provider Demographics
NPI:1942865696
Name:WILSON, LINDSAY PAIGE (LCPC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:PAIGE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20360 STATE HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:ASHMORE
Mailing Address - State:IL
Mailing Address - Zip Code:61912-9141
Mailing Address - Country:US
Mailing Address - Phone:217-549-1690
Mailing Address - Fax:
Practice Address - Street 1:304 8TH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-1504
Practice Address - Country:US
Practice Address - Phone:217-345-4642
Practice Address - Fax:217-210-0227
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008614101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor