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General NPI Number Information
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NPI Number | 1457998452
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Entity Type | Organization
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Legal Business Name | WILKS & WELLNESS, LLC
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 112 SPENCER ST STE 3B
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City | MANCHESTER
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State | CT
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Zip | 06040-4601
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Country | US
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Telephone | 860-812-4320
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Fax | 866-355-1052
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Provider Business Mailing Address
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Address Line | 112 SPENCER ST STE 3B
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City | MANCHESTER
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State | CT
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Zip | 06040-4601
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Country | US
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Telephone | 860-812-4320
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Fax | 866-355-1052
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. SHANNON LEE WILKS
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Credential | LCSW
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Telephone | 860-812-4320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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