Healthcare Provider Details

I. General information

NPI: 1144124934
Provider Name (Legal Business Name): LAQUANDA MONIC WILKERSON MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 KNOTTS LNDG
FOREST CITY NC
28043-3151
US

IV. Provider business mailing address

123 KNOTTS LNDG
FOREST CITY NC
28043-3151
US

V. Phone/Fax

Practice location:
  • Phone: 980-677-6509
  • Fax:
Mailing address:
  • Phone: 980-677-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024376
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: