Provider Demographics
NPI:1801165865
Name:WILKINSON, NATALIE (MA, LLP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1267
Mailing Address - Country:US
Mailing Address - Phone:734-564-3643
Mailing Address - Fax:
Practice Address - Street 1:203 W MICHIGAN AVE STE 306
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1329
Practice Address - Country:US
Practice Address - Phone:734-564-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008015103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling