Provider Demographics
NPI:1356482483
Name:WILKERSON, INGRID NICOLA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:NICOLA
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6892 CHESWICK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-2257
Mailing Address - Country:US
Mailing Address - Phone:770-994-0997
Mailing Address - Fax:770-996-3030
Practice Address - Street 1:6892 CHESWICK DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-2257
Practice Address - Country:US
Practice Address - Phone:770-994-0997
Practice Address - Fax:770-996-3030
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0028981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical