Provider Demographics
NPI:1285197228
Name:WILCOX, KENYA (LMSW)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 MARTIN LUTHER AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35228-3636
Mailing Address - Country:US
Mailing Address - Phone:205-434-5989
Mailing Address - Fax:
Practice Address - Street 1:650 9TH AVE SW STE 100
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4502
Practice Address - Country:US
Practice Address - Phone:205-267-4463
Practice Address - Fax:205-800-7244
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4195G101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty