Provider Demographics
NPI:1982220547
Name:WILKENS, KIONTE D (ADT)
Entity Type:Individual
Prefix:
First Name:KIONTE
Middle Name:D
Last Name:WILKENS
Suffix:
Gender:F
Credentials:ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8171 ROBINSON JEFFERSON DR APT 214
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7265
Mailing Address - Country:US
Mailing Address - Phone:443-538-0253
Mailing Address - Fax:
Practice Address - Street 1:1801 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3503
Practice Address - Country:US
Practice Address - Phone:410-354-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)