Provider Demographics
NPI:1003617168
Name:WILKERSON, DANETTE ELAINE (MA, NCC)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:ELAINE
Last Name:WILKERSON
Suffix:
Gender:
Credentials:MA, NCC
Other - Prefix:
Other - First Name:DANNETE
Other - Middle Name:ELAINE
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, NCC
Mailing Address - Street 1:595 E COLORADO BLVD STE 635
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2032
Mailing Address - Country:US
Mailing Address - Phone:310-895-5692
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 635
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2032
Practice Address - Country:US
Practice Address - Phone:310-895-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA17463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health