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NPI Code Detail

MEDICARE: ERICA DENISE WILKERSON LICSW IBCLC PMHC MAC

MEDICARE: ERICA DENISE WILKERSON LICSW IBCLC PMHC MAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerMSW005379GA
21041C0700XClinical Social WorkerC015272NC
31041C0700XClinical Social Worker114793TX
41041C0700XClinical Social WorkerCSW005659GA
5174N00000XLactation Consultant (Non-RN)L-313128
6101YA0400XAddiction (Substance Use Disorder) Counselor509237
71041C0700XClinical Social WorkerLICSW1120178MA

General Provider Information

NPI Number : 1881942662
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA DENISE WILKERSON LICSW IBCLC PMHC MAC
Provider Business Mailing Address
First Line : 4030 WAKE FOREST RD STE 349
Second Line :
City : RALEIGH
State : NC
Zip : 27609-0010
Country : US
Telephone Number : 919-830-1013
Fax Number :
Provider Business Practice Location Address
First Line : 4030 WAKE FOREST RD STE 349
Second Line :
City : RALEIGH
State : NC
Zip : 27609-0010
Country : US
Telephone Number : 919-830-1013
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2012
Last Update Date : 05/05/2026

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