Provider Demographics
NPI:1669409850
Name:WILKE, CHRISTINE MICHELE (EDS LMFT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MICHELE
Last Name:WILKE
Suffix:
Gender:F
Credentials:EDS LMFT
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:MICHELE
Other - Last Name:GOMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:305 HILLVIEW DR
Mailing Address - Street 2:A
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064
Mailing Address - Country:US
Mailing Address - Phone:610-746-3054
Mailing Address - Fax:610-746-3054
Practice Address - Street 1:139 N THIRD ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-746-3087
Practice Address - Fax:610-746-3054
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000268106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50026970OtherCBC GROUP NUMBER
PA50027094OtherCAPITAL BLUE CROSS