Provider Demographics
NPI:1639326549
Name:WILKES, RONNIE LEE JR (LPC, CRC)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:LEE
Last Name:WILKES
Suffix:JR
Gender:M
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CHARLESTOWNE CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5717
Mailing Address - Country:US
Mailing Address - Phone:336-416-8275
Mailing Address - Fax:
Practice Address - Street 1:500 W NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-6526
Practice Address - Country:US
Practice Address - Phone:336-748-9028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00099107101Y00000X
NC6970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor