Doctor Name: | MISS LYNDA L WICK |
NPI Number: | 1134370042 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | E0001623SUPV |
Business Practice Address: | 700 City Hall Dr Lmcs Ft Oglethorpe, GA - 307427802 |
Business Phone Number: | 7068613387 |
Business Fax Number: | 7066385541 |
Mailing Address: | 700 City Hall Dr, Lmcs FT OGLETHORPE |
State: | GA |
Postal Code: | 307427802 |
Phone Number: | 7068613387 |
Fax Number: | 7066385541 |
NPI Enumeration Date: | 10/09/2008 |
NPI Last Update Date: | 10/09/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | E0001623SUPV |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |