Provider Demographics
NPI:1780283465
Name:WILSON, RACHEAL (LPCC)
Entity type:Individual
Prefix:
First Name:RACHEAL
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 OAKMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4005
Mailing Address - Country:US
Mailing Address - Phone:216-407-8967
Mailing Address - Fax:
Practice Address - Street 1:8224 MENTOR AVE STE 208
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5743
Practice Address - Country:US
Practice Address - Phone:440-392-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2304790101YP2500X
OHE.2505022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional