Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dominique Marie Wilson, MA, LCPC, CRC

Individual provider Counselor · NPI 1407345192

Dominique Marie Wilson, MA, LCPC, CRC is a Mental Health Counselor in O Fallon, Illinois. Qualified in 2017, 9 years ago. Practices with Serene Path Wellness, a 3-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois and Nevada.

Years since qualifying
9
Licensed in
IL, NV
In the registry since
2018
Specialties on file
3
What do these letters mean?
MA — Master of Arts
A graduate arts degree.
LCPC — Licensed Clinical Professional Counselor
A licensed clinical counsellor.

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Practice location Address checks out

785 Wall St # 200
O Fallon, IL 62269-1959
Phone: (618) 367-2194
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3550 W Cheyenne Ave, North Las Vegas, NV 89032-8212 — (702) 570-5421

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 180.012945 (IL)
Counselor Taxonomy 101Y00000X · Licence CI0365 (NV)
Mental Health Counselor Taxonomy 101YM0800X · Licence CI0365 (NV)

Record details

NPI number1407345192
Entity typeIndividual (Type 1)
GenderFemale
Credentials MA , LCPC , CRC
Sole proprietorYes
NPI enumeratedMay 8, 2018
Last updated in NPPESAugust 11, 2020
Certification dateAugust 11, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Serene Path Wellness — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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