Provider Demographics
NPI:1326101221
Name:WILKERSON, TIMOTHY CRAIG (LMSW)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 INTERSTATE BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5715
Mailing Address - Country:US
Mailing Address - Phone:864-297-4275
Mailing Address - Fax:864-297-4277
Practice Address - Street 1:121 INTERSTATE BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5715
Practice Address - Country:US
Practice Address - Phone:864-297-4275
Practice Address - Fax:864-297-4277
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical