Provider Demographics
NPI:1932877867
Name:WILKES, ANDRE LAMOND SR (SUD REG COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:LAMOND
Last Name:WILKES
Suffix:SR
Gender:M
Credentials:SUD REG COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 AUSTIN AVE APT 713
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-8505
Mailing Address - Country:US
Mailing Address - Phone:510-470-2046
Mailing Address - Fax:
Practice Address - Street 1:2035 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1088
Practice Address - Country:US
Practice Address - Phone:510-346-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health