Organization
MINDY WILKERSON, LCSW, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINDY WILKERSON LCSW (MENTAL HEALTH THERAPIST)
(314) 922-4558
Entity
Organization
Contact information
Practice address
19 E MOUNTAIN ST, FAYETTEVILLE, AR 72701-6067
(479) 222-1671
Mailing address
22578 OAKVIEW RD, SILOAM SPRINGS, AR 72761-8246
(314) 922-4558
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396283875
INDIVIDUAL NPI
—
Enumeration date
11/13/2020
Last updated
11/13/2020
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