Provider Demographics
NPI:1811225873
Name:WILKINS, QUINCY L (MFT)
Entity Type:Individual
Prefix:MR
First Name:QUINCY
Middle Name:L
Last Name:WILKINS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8763
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94662-0763
Mailing Address - Country:US
Mailing Address - Phone:510-610-2026
Mailing Address - Fax:510-619-7222
Practice Address - Street 1:6355 TELEGRAPH AVE STE 308
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1375
Practice Address - Country:US
Practice Address - Phone:510-610-2026
Practice Address - Fax:510-619-7222
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist