Provider Demographics
NPI:1093137341
Name:WILKINSON, LAURA (LPC/I)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:LPC/I
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 31447
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-0025
Mailing Address - Country:US
Mailing Address - Phone:843-273-0077
Mailing Address - Fax:214-716-1170
Practice Address - Street 1:9403 HIGHWAY 707
Practice Address - Street 2:SUITE B
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7758
Practice Address - Country:US
Practice Address - Phone:843-273-0077
Practice Address - Fax:214-716-1170
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health