Doctor Name: | DR. TONICA WICKER |
NPI Number: | 1003207705 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | LH60461035 |
Business Practice Address: | 810 77th Dr Se Lake Stevens, WA - 982587393 |
Business Phone Number: | 8082928706 |
Business Fax Number: | |
Mailing Address: | 2312 Rucker Ave, EVERETT |
State: | WA |
Postal Code: | 982012723 |
Phone Number: | 8082924919 |
Fax Number: | |
NPI Enumeration Date: | 02/17/2015 |
NPI Last Update Date: | 02/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LH60461035 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |