Provider Demographics
NPI:1437568698
Name:WILKERSON, TREVIA D
Entity Type:Individual
Prefix:MS
First Name:TREVIA
Middle Name:D
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TREVIA
Other - Middle Name:D
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2020 PAUL W BRYANT DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2312
Mailing Address - Country:US
Mailing Address - Phone:205-752-2504
Mailing Address - Fax:205-345-4842
Practice Address - Street 1:2020 PAUL W BRYANT DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2312
Practice Address - Country:US
Practice Address - Phone:205-752-2504
Practice Address - Fax:205-345-4842
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional