Provider Demographics
NPI:1790014397
Name:WILKINS, MERCEDES CRISTINA (ABA IMPLEMENTER)
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:CRISTINA
Last Name:WILKINS
Suffix:
Gender:F
Credentials:ABA IMPLEMENTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17455 S INDIGO MESA PASS
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2762
Mailing Address - Country:US
Mailing Address - Phone:520-207-4432
Mailing Address - Fax:
Practice Address - Street 1:17455 S INDIGO MESA PASS
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-2762
Practice Address - Country:US
Practice Address - Phone:520-207-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst