Provider Demographics
NPI:1891118725
Name:WILKERSON, LYNDA (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LCSW
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 341
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-0341
Mailing Address - Country:US
Mailing Address - Phone:270-384-6740
Mailing Address - Fax:270-384-6971
Practice Address - Street 1:127 NORTH REED STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-0341
Practice Address - Country:US
Practice Address - Phone:270-384-6740
Practice Address - Fax:270-384-6971
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-8871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical