Provider Demographics
NPI:1316102064
Name:WILKERSON, GINGER L (MFT)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:L
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:GINGER
Other - Middle Name:L
Other - Last Name:LAVENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:10221 S COMPTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002
Mailing Address - Country:US
Mailing Address - Phone:213-385-5100
Mailing Address - Fax:323-566-1638
Practice Address - Street 1:10221 S COMPTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002
Practice Address - Country:US
Practice Address - Phone:213-385-5100
Practice Address - Fax:323-566-1638
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51578106H00000X
CA57286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist