Provider Demographics
NPI:1659888535
Name:WILKINS, CARMEN RANAE
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:RANAE
Last Name:WILKINS
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 1:1010 E ADAMS ST STE 111
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-1902
Mailing Address - Country:US
Mailing Address - Phone:904-559-9094
Mailing Address - Fax:
Practice Address - Street 1:1010 E ADAMS ST STE 111
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-1902
Practice Address - Country:US
Practice Address - Phone:904-559-9094
Practice Address - Fax:904-559-9094
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health