Wilson, Dominique Marie

Wilson, Dominique Marie is an sole proprietor health care provider with primary practice located at 785 Wall St # 200 , O Fallon IL 62269-1959. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Wilson, Dominique Marie can be contacted via phone (618) 367-2194.

Contact Information

Primary practice address
785 Wall St # 200 O Fallon IL 62269-1959
Phone: (618) 367-2194
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X CI0365 Nevada
Behavioral Health & Social Service Providers / Mental Health 101YM0800X CI0365 Nevada
Behavioral Health & Social Service Providers / Professional 101YP2500X 180.012945 Illinois

Profile Details

NPI number 1407345192
LBN Legal business name Wilson, Dominique Marie
Credentials MA, LCPC, CRC
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 8th, 2018
Last updated Aug 11th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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