Provider Demographics
NPI:1003219049
Name:WILKINSON, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WITHERELL ST
Mailing Address - Street 2:APT 250
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-1661
Mailing Address - Country:US
Mailing Address - Phone:248-408-3565
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER PLACE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4274
Practice Address - Country:US
Practice Address - Phone:313-871-2337
Practice Address - Fax:313-871-1805
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085149104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker