Provider Demographics
NPI:1831382613
Name:WILKS, ABRAM DILLON (PLCSW)
Entity type:Individual
Prefix:
First Name:ABRAM
Middle Name:DILLON
Last Name:WILKS
Suffix:
Gender:M
Credentials:PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 S BEARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-9557
Mailing Address - Country:US
Mailing Address - Phone:573-874-8686
Mailing Address - Fax:573-874-8608
Practice Address - Street 1:1731 LOUISE CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3892
Practice Address - Country:US
Practice Address - Phone:573-442-3429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070251051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical