MEDICARE: DR. ALEXIS L WILKERSON MCDONALD LPC, LCMHC, PMH

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	101YP2500X	Professional Counselor	0701009914	VA
2	101YP2500X	Professional Counselor	19418	NC

General Provider Information

NPI Number	:	1730763814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS L WILKERSON MCDONALD LPC, LCMHC, PMH

Provider Business Mailing Address
First Line	:	1011 E MAIN ST STE 310
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23219-3537
Country	:	US
Telephone Number	:	610-680-0278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 E MAIN ST STE 310
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23219-3537
Country	:	US
Telephone Number	:	610-680-0278
Fax Number	:

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	04/15/2025

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