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General NPI Number Information
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NPI Number | 1407183460
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Entity Type | Organization
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Legal Business Name | WILKERBURY, LLC
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 890 W KING ST SUITE 108
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City | BOONE
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State | NC
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Zip | 28607-4690
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Country | US
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Telephone | 828-850-7825
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Fax | 828-355-9758
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Provider Business Mailing Address
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Address Line | PO BOX 1280
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City | BOONE
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State | NC
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Zip | 28607-1280
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Country | US
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Telephone | 828-850-7825
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Fax | 828-355-9758
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | MR. TREVOR ALAN WILKERSON
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Credential | MA LPC
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Telephone | 828-850-7825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5250
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License Number State | NC
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