Provider Demographics
NPI:1083771737
Name:WILKERSON, DAVID A (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 E MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1440
Mailing Address - Country:US
Mailing Address - Phone:317-881-5050
Mailing Address - Fax:
Practice Address - Street 1:896 E MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1440
Practice Address - Country:US
Practice Address - Phone:317-881-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000809A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0619180000OtherMAGELLAN
IN34000809AOtherCLINICAL SOCIAL WORKER
IN000000182668OtherANTHEM