Healthcare Provider Details

I. General information

NPI: 1780838185
Provider Name (Legal Business Name): WILKINSONS AND ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 E US HIGHWAY 40 UNIT C
TROY IL
62294-2262
US

IV. Provider business mailing address

8812 ROSEWOOD HILLS DR
EDWARDSVILLE IL
62025-7038
US

V. Phone/Fax

Practice location:
  • Phone: 618-580-8969
  • Fax:
Mailing address:
  • Phone: 618-580-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180-000308
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01773
License Number StateMO

VIII. Authorized Official

Name: DR. ALVIN D WILKINSON
Title or Position: PRESIDENT
Credential: ED.D.
Phone: 618-580-8969