Provider Demographics
NPI:1760243463
Name:WILKES, BREEONA M (RESIDENT IN COUNSELI)
Entity Type:Individual
Prefix:
First Name:BREEONA
Middle Name:M
Last Name:WILKES
Suffix:
Gender:F
Credentials:RESIDENT IN COUNSELI
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:739 THIMBLE SHOALS BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3562
Mailing Address - Country:US
Mailing Address - Phone:757-838-1960
Mailing Address - Fax:757-868-3280
Practice Address - Street 1:348 MCLAWS CIRCLE
Practice Address - Street 2:UNIT 1
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6349
Practice Address - Country:US
Practice Address - Phone:757-838-1960
Practice Address - Fax:757-838-3280
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0704016526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional