Provider Demographics
NPI:1497220651
Name:WILKINS, CAROLYN NOREEN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:NOREEN
Last Name:WILKINS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 COOLIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34945-3132
Mailing Address - Country:US
Mailing Address - Phone:772-370-3404
Mailing Address - Fax:
Practice Address - Street 1:2681 COOLIDGE RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34945-3132
Practice Address - Country:US
Practice Address - Phone:772-370-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-18-30344103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst