Provider Demographics
NPI:1992180293
Name:WILKINS, KATHRYNE NOEL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYNE
Middle Name:NOEL
Last Name:WILKINS
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 1:11836 GRAND HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-4949
Mailing Address - Country:US
Mailing Address - Phone:936-488-9057
Mailing Address - Fax:936-598-5007
Practice Address - Street 1:11836 GRAND HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-4949
Practice Address - Country:US
Practice Address - Phone:936-488-9057
Practice Address - Fax:936-598-5007
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX524661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical