Provider Demographics
NPI:1780026732
Name:WILKIE, MATTHEW JAY (LISW-CP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAY
Last Name:WILKIE
Suffix:
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 DAUFASKIE RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1895
Mailing Address - Country:US
Mailing Address - Phone:803-406-1394
Mailing Address - Fax:
Practice Address - Street 1:3133 DAUFASKIE RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1895
Practice Address - Country:US
Practice Address - Phone:803-406-1394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
SC10378104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker