Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | MD | |
Y | 103K00000X | Behavior Analyst | LBA710 | MD |
N | 103TS0200X | School Psychologist | MD |
NPI | 1083258107 |
---|---|
Provider Name | Mark Wilkerson |
First Address | Columbia, MD 21045-2565 |
Second Address | Columbia, MD 21045-2565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2019 |
Last Update Date | 31/10/2019 |