Provider Demographics
NPI:1023363306
Name:WILKEY, ROBIN (MFT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:WILKEY
Suffix:
Gender:F
Credentials:MFT
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 703
Mailing Address - Street 2:
Mailing Address - City:KENWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:95452-0703
Mailing Address - Country:US
Mailing Address - Phone:707-573-6070
Mailing Address - Fax:
Practice Address - Street 1:722 SPRING ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3902
Practice Address - Country:US
Practice Address - Phone:707-573-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMT19847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist