Provider Demographics
NPI:1699401513
Name:WILKS, DZYRE MONEJAH
Entity Type:Individual
Prefix:
First Name:DZYRE
Middle Name:MONEJAH
Last Name:WILKS
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 1:4470 LITTLE RIVER INN LN APT 1007
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-6090
Mailing Address - Country:US
Mailing Address - Phone:845-701-6970
Mailing Address - Fax:
Practice Address - Street 1:6215 HIGHWAY 707
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7362
Practice Address - Country:US
Practice Address - Phone:843-273-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15258104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker