Provider Demographics
NPI:1871127753
Name:WILKERSON, JEANINE ROCHELLE (LCSWA)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:ROCHELLE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 POPLAR GROVE CT
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-6925
Mailing Address - Country:US
Mailing Address - Phone:317-875-2054
Mailing Address - Fax:
Practice Address - Street 1:304C W UNION ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3729
Practice Address - Country:US
Practice Address - Phone:828-655-3134
Practice Address - Fax:828-475-6197
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0135251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical