Provider Demographics
NPI:1073780631
Name:WILKIE, MARY SUSAN (PHD LPC LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:WILKIE
Suffix:
Gender:F
Credentials:PHD LPC LMFT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:B
Other - Last Name:WILKIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LPC LMFT
Mailing Address - Street 1:730 HANNA WOODS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRAMERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28032
Mailing Address - Country:US
Mailing Address - Phone:504-236-5642
Mailing Address - Fax:
Practice Address - Street 1:730 HANNA WOODS DRIVE
Practice Address - Street 2:
Practice Address - City:CRAMERTON
Practice Address - State:NC
Practice Address - Zip Code:28032
Practice Address - Country:US
Practice Address - Phone:504-236-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC1821LA101Y00000X
NC5463NC101Y00000X
LAMFT299LA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor