Provider Demographics
NPI:1669809620
Name:WILKINS, DANA SHEA (LCASA CSOTS)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:SHEA
Last Name:WILKINS
Suffix:
Gender:F
Credentials:LCASA CSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2921 MILLBROOK WOODS DR
Mailing Address - Street 2:APT 004
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2976
Mailing Address - Country:US
Mailing Address - Phone:336-908-0535
Mailing Address - Fax:
Practice Address - Street 1:1001 NAVAHO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7335
Practice Address - Country:US
Practice Address - Phone:919-872-1178
Practice Address - Fax:800-879-8149
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X
NC2845-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor