Dominique Marie Wilson, MA, LCPC, CRC
NPI 1407345192ActiveIndividual· Counselor, Professional· O Fallon, IL
Counselor, Professional (MA, LCPC, CRC) with Serene Path Wellness, practicing in O Fallon, Illinois. Enrolled in Medicare as practitioner - mental health counselor.
Overview
| NPI | 1407345192 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | MA, LCPC, CRC |
| Sole proprietor | Yes |
| NPI issued | May 8, 2018 |
| Last updated in NPPES | Aug 11, 2020 |
| Certified by provider | Aug 11, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Professional Primary | 101YP2500X | 180.012945 | IL |
| Counselor | 101Y00000X | CI0365 | NV |
| Counselor, Mental Health | 101YM0800X | CI0365 | NV |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Mental Health Counselor (NV) |
|---|
Education and affiliations
| Graduation year | 2017 |
|---|---|
| Medicare specialty | Mental Health Counselor |
Medical group
- Serene Path WellnessLas Vegas, NV · 3 clinicians
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