Organization
JONATHAN WILKS, LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN DANIEL WILKS LCSW (OWNER)
(505) 553-6110
Entity
Organization
Contact information
Practice address
4300 WOODROSE RD NW, ALBUQUERQUE, NM 87114-5578
(505) 553-6110
Mailing address
4300 WOODROSE RD NW, ALBUQUERQUE, NM 87114-5578
(505) 553-6110
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08027242
—
NM
Enumeration date
06/09/2020
Last updated
05/28/2022
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