Provider Demographics
NPI:1821766528
Name:WILKINSON, MATTHEW A (LCPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OAK DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5635
Mailing Address - Country:US
Mailing Address - Phone:618-520-0574
Mailing Address - Fax:618-205-3561
Practice Address - Street 1:3 OAK DR STE B
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5635
Practice Address - Country:US
Practice Address - Phone:618-972-1568
Practice Address - Fax:618-205-3561
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
178.014083101YP2500X
IL180.015654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional