IndividualActive
Dominique Wilson, MA, LCPC, CRC
NPI 1407345192 · Professional Counselor · O Fallon, IL
Provider details
- NPI number
- 1407345192
- Entity type
- Individual
- Primary specialty
- Professional CounselorBehavioral Health & Social Service Providers
- Credential
- MA, LCPC, CRC
- Sex
- Female
- Sole proprietor
- Yes
- License
- CI0365 (NV)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Behavioral Health & Social Service Providers
Behavioral Health & Social Service Providers
Profile Score
Established profile(73/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
785 Wall St # 200
O Fallon, IL 62269-1959
Phone: (618) 367-2194
Street-level locationGet directions
Mailing address
1109 High Valley Ln
Belleville, IL 62221-6846
Additional practice locations (1)
- 3550 W Cheyenne AveNorth Las Vegas, NV 89032-8212Phone: (702) 570-5421
Registry dates
- Enumerated
- 2018-05-08
- Last updated
- 2020-08-11
- Certified
- 2020-08-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.