Provider Demographics
NPI:1134350663
Name:WILKINS, DENISE RACHELLE (LADC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:RACHELLE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5618 WINNETKA AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3315
Mailing Address - Country:US
Mailing Address - Phone:612-977-1822
Mailing Address - Fax:612-236-1701
Practice Address - Street 1:1121 JACKSON ST NE STE 105
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1665
Practice Address - Country:US
Practice Address - Phone:612-236-1700
Practice Address - Fax:612-236-1701
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302623101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)