MEDICARE: MR. TREVOR A. WILKERSON LPC

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	5250	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1412E	OTHER	NC	BLUECROSS BLUESHIELD OF N

General Provider Information

NPI Number	:	1801845128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TREVOR A. WILKERSON LPC

Provider Business Mailing Address
First Line	:	132 POPLAR GROVE CONNECTOR
Second Line	:	SUITE B
City	:	BOONE
State	:	NC
Zip	:	28607-5915
Country	:	US
Telephone Number	:	828-264-8759
Fax Number	:	828-262-5687

Provider Business Practice Location Address
First Line	:	895 STATE FARM RD
Second Line	:	SUITE 508
City	:	BOONE
State	:	NC
Zip	:	28607-4917
Country	:	US
Telephone Number	:	828-264-9007
Fax Number	:	828-262-5687

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	07/08/2007

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