Provider Demographics
NPI:1548702715
Name:WILKINS, TIMOTHY (LPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WILKINS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3976
Mailing Address - Country:US
Mailing Address - Phone:734-645-8944
Mailing Address - Fax:
Practice Address - Street 1:2155 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3976
Practice Address - Country:US
Practice Address - Phone:734-645-8944
Practice Address - Fax:734-645-8944
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000928390200000X
MI6401015474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program