Provider Demographics
NPI:1285108159
Name:WILCOX, KRISTIN (MS, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MS, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 STINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2340
Mailing Address - Country:US
Mailing Address - Phone:612-220-6437
Mailing Address - Fax:
Practice Address - Street 1:2546 JOHNSON ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3941
Practice Address - Country:US
Practice Address - Phone:904-370-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02088101YM0800X, 101YM0800X
MN304735101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)