MEDICARE: LAURA WILKINSON LPC/I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5412	SC

General Provider Information

NPI Number	:	1093137341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA WILKINSON LPC/I

Provider Business Mailing Address
First Line	:	PO BOX 31447
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-0025
Country	:	US
Telephone Number	:	843-273-0077
Fax Number	:	214-716-1170

Provider Business Practice Location Address
First Line	:	9403 HIGHWAY 707
Second Line	:	SUITE B
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7758
Country	:	US
Telephone Number	:	843-273-0077
Fax Number	:	214-716-1170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/06/2014

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