Provider Demographics
NPI:1942896089
Name:WILSON, HELEN S (LPCA)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 CAMDEN WAY
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-3777
Mailing Address - Country:US
Mailing Address - Phone:803-439-2519
Mailing Address - Fax:
Practice Address - Street 1:3145 CAMDEN WAY
Practice Address - Street 2:
Practice Address - City:GRANITEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29829-3777
Practice Address - Country:US
Practice Address - Phone:803-439-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007384101YP2500X
SC7268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional