Provider Demographics
NPI:1154593341
Name:WILKINSON, ALICE JEAN (LISAC)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:JEAN
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:A
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISAC
Mailing Address - Street 1:1316 E LEMON ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-4323
Mailing Address - Country:US
Mailing Address - Phone:480-966-4932
Mailing Address - Fax:
Practice Address - Street 1:3311 N. 44TH ST.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85281
Practice Address - Country:US
Practice Address - Phone:602-957-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-1261101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)