Provider Demographics
NPI:1174833693
Name:WILKES, CHRISTOPHER (LCSW, CAADC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:WILKES
Suffix:
Gender:M
Credentials:LCSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3868
Mailing Address - Country:US
Mailing Address - Phone:601-545-2442
Mailing Address - Fax:601-545-2443
Practice Address - Street 1:207 3RD AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3868
Practice Address - Country:US
Practice Address - Phone:601-545-2442
Practice Address - Fax:601-545-2443
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC70181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical