Provider Demographics
NPI:1306078373
Name:WILKEY, BENNY KEITH (LMSW)
Entity type:Individual
Prefix:MR
First Name:BENNY
Middle Name:KEITH
Last Name:WILKEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-6815
Mailing Address - Country:US
Mailing Address - Phone:912-489-1092
Mailing Address - Fax:
Practice Address - Street 1:116 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30461-6815
Practice Address - Country:US
Practice Address - Phone:912-489-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW002654104100000X
GAS5- CERTIFICATION1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool