Provider Demographics
NPI:1376601880
Name:WYKLE, JOHN GRANT (MSW, ACSW, LCSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GRANT
Last Name:WYKLE
Suffix:
Gender:M
Credentials:MSW, ACSW, LCSW, BCD
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:GRANT
Other - Last Name:WYKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, ACSW, LCSW, BCD
Mailing Address - Street 1:41 EDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1543
Mailing Address - Country:US
Mailing Address - Phone:828-254-2545
Mailing Address - Fax:
Practice Address - Street 1:34 WALL ST
Practice Address - Street 2:SUITE # 403
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2725
Practice Address - Country:US
Practice Address - Phone:828-254-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0007891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89538OtherBLUE CROSS BLUE SHIELD
NC89538OtherBLUE CROSS BLUE SHIELD