Individual
MS. CHARLENE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LIMHP
Contact information
Practice address
105 N 31ST AVE STE 212, OMAHA, NE 68131-2915
(402) 378-8508
(402) 939-0676
Mailing address
105 N 31ST AVE STE 212, OMAHA, NE 68131-2915
(402) 378-8508
(402) 939-0676
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
1921
NE
101YP2500X
Professional Counselor
3878
NE
101YP2500X
Professional Counselor
Primary
960
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1921
PROFESSIONAL COUNSELOR
NE
01
—
960
LICENSE INDEPENDENT MENTAL HEALTH PRACTITIONER
NE
Enumeration date
01/02/2007
Last updated
01/12/2022
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