Provider Demographics
NPI:1265141402
Name:WILKINSON, MICHAEL LYN I
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYN
Last Name:WILKINSON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 GREENBRIER PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0686
Mailing Address - Country:US
Mailing Address - Phone:757-758-3042
Mailing Address - Fax:
Practice Address - Street 1:1403 GREENBRIER PKWY STE 500
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0686
Practice Address - Country:US
Practice Address - Phone:757-758-3042
Practice Address - Fax:757-601-8254
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional