Provider Demographics
NPI:1336495415
Name:WILKINSON, ALICE L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:L
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 14TH ST N
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-5416
Mailing Address - Country:US
Mailing Address - Phone:409-771-8262
Mailing Address - Fax:
Practice Address - Street 1:13012 HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2804
Practice Address - Country:US
Practice Address - Phone:409-771-8262
Practice Address - Fax:281-480-7856
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional