Healthcare Provider Details

I. General information

NPI: 1104369404
Provider Name (Legal Business Name): ALEXANDRIA NINA WILKENS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRIA WILKENS MSW, LCSW

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 PALMER DRIVE
RALEIGH NC
27699-1668
US

IV. Provider business mailing address

3413 FLAT RIVER DR
DURHAM NC
27703-7872
US

V. Phone/Fax

Practice location:
  • Phone: 919-855-3430
  • Fax:
Mailing address:
  • Phone: 919-764-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012048
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP010760
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: