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General NPI Number Information
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NPI Number | 1831704659
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Entity Type | Individual
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Provider Name | MICHAEL J WILKERSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 527 TUSKEGEE AIRMEN AVE
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City | SHEPPARD AFB
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State | TX
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Zip | 76311
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Country | US
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Telephone | 940-676-1420
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Fax |
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Provider Business Mailing Address
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Address Line | 527 TUSKEGEE AIRMEN AVE
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City | SHEPPARD AFB
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State | TX
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Zip | 76311
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Country | US
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Telephone | 940-676-1420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2020026573
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 11682
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License Number State | KS
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