Provider Demographics
NPI:1386833887
Name:WILKIE, CARRIE COLLEEN
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:COLLEEN
Last Name:WILKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 KAREN SUE PL
Mailing Address - Street 2:UNIT C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3985
Mailing Address - Country:US
Mailing Address - Phone:915-373-3558
Mailing Address - Fax:
Practice Address - Street 1:1917 KAREN SUE PL
Practice Address - Street 2:UNIT C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3985
Practice Address - Country:US
Practice Address - Phone:915-373-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39467104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker