Provider Demographics
NPI:1811038409
Name:WILKINSON, LISA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4742 42ND AVE SW # 184
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4553
Mailing Address - Country:US
Mailing Address - Phone:206-679-4878
Mailing Address - Fax:206-363-9639
Practice Address - Street 1:2743 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE 301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-6454
Practice Address - Country:US
Practice Address - Phone:206-679-4878
Practice Address - Fax:206-971-5072
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00010691OtherMENTAL HEALTH COUNSELOR LICENSE