Provider Demographics
NPI:1043469836
Name:WOLKINSON, ESTE.. L (MA, CSW, LPC)
Entity Type:Individual
Prefix:
First Name:ESTE..
Middle Name:L
Last Name:WOLKINSON
Suffix:
Gender:F
Credentials:MA, CSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 DURAND ST
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3523
Mailing Address - Country:US
Mailing Address - Phone:517-337-0710
Mailing Address - Fax:
Practice Address - Street 1:507 DURAND ST
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3523
Practice Address - Country:US
Practice Address - Phone:517-337-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000965101YP2500X
MI6801057288104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker