Provider Demographics
NPI:1801845128
Name:WILKERSON, TREVOR A (LPC)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:A
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 POPLAR GROVE CONNECTOR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5915
Mailing Address - Country:US
Mailing Address - Phone:828-264-8759
Mailing Address - Fax:828-262-5687
Practice Address - Street 1:895 STATE FARM RD
Practice Address - Street 2:SUITE 508
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-264-9007
Practice Address - Fax:828-262-5687
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1412EOtherBLUECROSS BLUESHIELD OF N