Individual provider · Type 1 NPI

Ishalon Shanquell Siedah Wilson, LMHC, LPC

Professional Counselor · Port St. Lucie, FL

NPI number 1750126470 Active

Practice location

4090 SW Jaqust St
Port St. Lucie, FL 34953-5626

Call (850) 631-0977 Map

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor 101YM0800XMH23967 (FL)
Professional Counselor Primary 101YP2500X99718 (TX)

Professional Counselor: Definition to come...

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About NPI 1750126470

Ishalon Shanquell Siedah Wilson, LMHC, LPC's National Provider Identifier is 1750126470, issued on Jun 25, 2024. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Port St. Lucie, FL. The record was last updated on Jan 20, 2026.