Individual
CARRIE BETH WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62781-0002
(217) 788-3000
Mailing address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 788-3000
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
180002793
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180002793
STATE LICENSE NUMBER
IL
Enumeration date
09/11/2007
Last updated
09/11/2007
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