Provider Demographics
NPI:1700130788
Name:TERRY WILKE, LCSW APC
Entity Type:Organization
Organization Name:TERRY WILKE, LCSW APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-300-8498
Mailing Address - Street 1:2515 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 317
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-300-8498
Mailing Address - Fax:
Practice Address - Street 1:2515 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 317
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-300-8498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LCS164811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty