Provider Demographics
NPI:1871617522
Name:WILKIE, MARY JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:WILKIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 ROGERS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4825
Mailing Address - Country:US
Mailing Address - Phone:828-265-4513
Mailing Address - Fax:
Practice Address - Street 1:2359 HIGHWAY 105
Practice Address - Street 2:CDSA OF THE BLUE RIDGE
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7814
Practice Address - Country:US
Practice Address - Phone:828-265-5391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046K9OtherBLUE CROSS BLUE SHIELD