Provider Demographics
NPI:1790498186
Name:WILKERSON, WILBERT (LMSW)
Entity Type:Individual
Prefix:
First Name:WILBERT
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 TOWNSEND WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-5094
Mailing Address - Country:US
Mailing Address - Phone:317-453-0700
Mailing Address - Fax:
Practice Address - Street 1:1311 W 96TH ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1172
Practice Address - Country:US
Practice Address - Phone:317-876-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99110552A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker