Provider Demographics
NPI:1134531650
Name:WILKERSON, LA TOYA (CPC-INTERN)
Entity type:Individual
Prefix:
First Name:LA TOYA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:CPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 VIA MANTOVA UNIT 302
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-2267
Mailing Address - Country:US
Mailing Address - Phone:702-328-1696
Mailing Address - Fax:702-360-0031
Practice Address - Street 1:30 VIA MANTOVA
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-2264
Practice Address - Country:US
Practice Address - Phone:702-710-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI5257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional