Provider Demographics
NPI:1568635944
Name:WILKERSON, JAMES KEITH (LMHC/STATE OF FLORID)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEITH
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:LMHC/STATE OF FLORID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 CHINOOK TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2714
Mailing Address - Country:US
Mailing Address - Phone:904-874-8162
Mailing Address - Fax:
Practice Address - Street 1:1337 CHINOOK TRAIL CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2714
Practice Address - Country:US
Practice Address - Phone:904-874-8162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health