Provider Demographics
NPI:1689256018
Name:WILKERSON, LYNNE MIDGETT (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:MIDGETT
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5624 LANCELOT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0424
Mailing Address - Country:US
Mailing Address - Phone:704-763-7056
Mailing Address - Fax:
Practice Address - Street 1:3315 SPRINGBANK LN STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3198
Practice Address - Country:US
Practice Address - Phone:704-763-7056
Practice Address - Fax:980-819-5798
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health