Healthcare Provider Details

I. General information

NPI: 1568679009
Provider Name (Legal Business Name): GAIL KRISTEN WILKES MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N MARKET ST
LANCASTER PA
17603-3003
US

IV. Provider business mailing address

321 N MARKET ST
LANCASTER PA
17603-3003
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-5334
  • Fax: 717-394-8747
Mailing address:
  • Phone: 717-394-5334
  • Fax: 717-394-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: