Provider Demographics
NPI:1457179103
Name:WILKERSON, ALICE C (LMSW)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:C
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:C
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4939 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1741
Mailing Address - Country:US
Mailing Address - Phone:301-768-0925
Mailing Address - Fax:
Practice Address - Street 1:4939 78TH AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1741
Practice Address - Country:US
Practice Address - Phone:301-768-0925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30886104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker