Provider Demographics
NPI:1942042700
Name:WILKERSON, DYONNA (MS, LAPC)
Entity type:Individual
Prefix:
First Name:DYONNA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MS, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N 41ST ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2691
Mailing Address - Country:US
Mailing Address - Phone:980-288-2586
Mailing Address - Fax:
Practice Address - Street 1:123 S BROAD ST STE 2540
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19109-6601
Practice Address - Country:US
Practice Address - Phone:215-372-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty