Basic Information
| Provider Information | |||||||||
| NPI: | 1871127753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILKERSON | ||||||||
| FirstName: | JEANINE | ||||||||
| MiddleName: | ROCHELLE | ||||||||
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| Credential: | LCSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 298 POPLAR GROVE CT | ||||||||
| Address2: | |||||||||
| City: | TAYLORSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286816925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178752054 | ||||||||
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| Practice Location | |||||||||
| Address1: | 304C W UNION ST | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286553729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286553134 | ||||||||
| FaxNumber: | 8284756197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2020 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P013525 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.