| NPI | 1851639488 |
|---|---|
| Former Name | KEVIN JAMES WILKES |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MA 463166) |
| 101YS0200X Counselor, School (Licence: CT C062011002701) | |
| 101YS0200X Counselor, School (Licence: PA 10606058) | |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2013-01-16 |