Provider Demographics
NPI:1275880460
Name:WILKERSON, DENISE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 CENTRAL BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2360
Mailing Address - Country:US
Mailing Address - Phone:925-375-5516
Mailing Address - Fax:
Practice Address - Street 1:1210 CENTRAL BLVD STE 125
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2360
Practice Address - Country:US
Practice Address - Phone:925-375-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 68137106H00000X
CALMFT 97794106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist