Provider Demographics
NPI:1639301377
Name:WILKINSON, CHARITY BETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:BETH
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUILDING 3508, ROUGH RIDER VILLAGE, DARNALL LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5005
Mailing Address - Country:US
Mailing Address - Phone:724-309-7273
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 3508
Practice Address - Street 2:ROUGH RIDER VILLAGE, DARNALL LOOP
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5005
Practice Address - Country:US
Practice Address - Phone:724-309-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical