Provider Demographics
NPI:1679352587
Name:WILKERSON, TANYA (LMSW-CC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:ME
Mailing Address - Zip Code:04944-0159
Mailing Address - Country:US
Mailing Address - Phone:207-238-4000
Mailing Address - Fax:
Practice Address - Street 1:16 PRESCOTT DRIVE
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:ME
Practice Address - Zip Code:04944
Practice Address - Country:US
Practice Address - Phone:207-238-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC225021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical