Provider Demographics
NPI:1053961524
Name:WILSON-THOMAS, ALICIA ANN (NCC, LCPC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:WILSON-THOMAS
Suffix:
Gender:F
Credentials:NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 S LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-4136
Mailing Address - Country:US
Mailing Address - Phone:773-368-6153
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST STE 1835
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1836
Practice Address - Country:US
Practice Address - Phone:312-940-3655
Practice Address - Fax:312-374-4966
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional