Provider Demographics
NPI:1255714184
Name:WILKIE, THOMAS A (MHC-LP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:WILKIE
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4175
Mailing Address - Country:US
Mailing Address - Phone:718-777-6375
Mailing Address - Fax:718-728-3207
Practice Address - Street 1:421 27TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4175
Practice Address - Country:US
Practice Address - Phone:718-777-6375
Practice Address - Fax:718-728-3207
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP96732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health