DOMINIQUE MARIE WILSON (NPI# 1407345192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407345192 |
| Entity Type | Individual |
| Full Name | DOMINIQUE MARIE WILSON |
| Credential | MA, LCPC, CRC |
| Practice Address |
785 Wall St # 200 O Fallon IL 62269-1959 |
| Mailing Address |
1109 High Valley Ln Belleville IL 62221-6846 |
| Practice Telephone | 6183672194 |
| Mailing Telephone | 3179006556 |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2020-08-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | CI0365 | NV | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
CI0365 | NV | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
180.012945 | IL | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3550 W Cheyenne Ave, North Las Vegas, NV 890328212 | 7025705421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831478023 | Dominique Lashan Wilson | Counselor | 1099 S Broadway, Ste. 260 and 280, Lexington, KY 40504-3030 | 2011-08-05 |
| 1518567874 | Dominique Wilson | Midwife | 14961 W Bell Rd Ste 175, Surprise, AZ 85374-3220 | 2020-10-27 |
| 1467081109 | Dominique Wilson | Occupational Therapist | 14906 Jefferson Davis Hwy, Woodbridge, VA 22191-4016 | 2020-04-04 |
| 1225502065 | Dominique Wilson | Physical Therapist | 14405 Laurel Pl Ste 102, Laurel, MD 20707-6102 | 2019-01-15 |
| 1750867511 | Dominique Wilson | Developmental Therapist | 1017 Fayetteville Rd Se # B, Atlanta, GA 30316-2932 | 2018-07-16 |
| 1295019909 | Dominique Renee Wilson | Nurse Practitioner | 1380 River Bend Dr, Dallas, TX 75247-4914 | 2011-09-30 |
| Street Address |
785 WALL ST # 200 |
| City | O FALLON |
| State | IL |
| Zip Code | 62269-1959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497311716 | Transformative Beginnings, LLC | Social Worker | 785 Wall St # 200, O Fallon, IL 62269-1959 | 2019-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683743 | Nicole Vandelinde | Counselor | 1805 Bowler Rd, O Fallon, IL 62269-7005 | 2020-09-15 |
| 1225641251 | Brenda French | Counselor | 302 Akoya Ct, O Fallon, MO 63366-4491 | 2020-08-28 |
| 1619590767 | Amanda Marie Dillard | Counselor | 981 Whitechapel Dr, O Fallon, IL 62269-7270 | 2020-05-23 |
| 1851922488 | Courtney Rydstrom | Counselor | 1001 Boardwalk Springs Pl Ste 113, O Fallon, MO 63368-4777 | 2020-02-02 |
| 1437610086 | Audrey Gonzalez | Counselor | 1941 Frank Scott Pkwy E Ste C, O Fallon, IL 62269-7387 | 2019-03-27 |
| 1356716054 | Starrynite Counseling, LLC | Counselor | 8 Eagle Ctr Ste 4, O Fallon, IL 62269-1963 | 2015-12-07 |
| 1699149161 | Cristine Lou Mason | Counselor | 2940 Wheatfield Farms Dr, O Fallon, MO 63368-7848 | 2015-11-21 |
| 1205185774 | Amy Christine Ilgenfritz | Counselor | 311 S Main St Ste 100, O Fallon, MO 63366-2807 | 2012-08-30 |
| 1861769184 | Counseling Associates of Southern Illinois | Counselor | 1669 Windham Way Ste B, O Fallon, IL 62269-3072 | 2011-12-01 |
| 1952609729 | Sharon Lynn Bass | Counselor | 7116 Twin Chimneys Blvd, O Fallon, MO 63368-8166 | 2011-03-03 |
| Find all providers in O FALLON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.