Provider Demographics
NPI:1467781104
Name:WILKS, BEVERLEY
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:
Last Name:WILKS
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:PO BOX 620262
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32762-0262
Mailing Address - Country:US
Mailing Address - Phone:321-278-6417
Mailing Address - Fax:
Practice Address - Street 1:452 OSCEOLA ST STE 114
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7800
Practice Address - Country:US
Practice Address - Phone:321-278-6417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool