Provider Demographics
NPI:1912527417
Name:WILKERSON, CANDICE (RBT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 ABLE CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3100
Mailing Address - Country:US
Mailing Address - Phone:251-410-0160
Mailing Address - Fax:251-410-5968
Practice Address - Street 1:2233 CAHABA VALLEY DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2602
Practice Address - Country:US
Practice Address - Phone:205-994-4474
Practice Address - Fax:334-283-2350
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-116371106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-20-116371OtherBEHAVIOR ANALYST CERTIFICATION BOARD