Provider Demographics
NPI:1417260746
Name:WILKIE, KATRINA M (LPA)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:M
Last Name:WILKIE
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 J N PEASE PLACE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-763-7386
Mailing Address - Fax:704-717-2440
Practice Address - Street 1:1945 J N PEASE PL
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4511
Practice Address - Country:US
Practice Address - Phone:704-763-7386
Practice Address - Fax:704-717-2440
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3965103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical