Doctor Name: | MR. TIM J MCVICKER |
NPI Number: | 1154416709 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CADAC II |
License Number: | A1431R |
Business Practice Address: | 255 N. Miami St. Wabash, IN - 46992 |
Business Phone Number: | 2605638446 |
Business Fax Number: | 2605631902 |
Mailing Address: | 850 N. Harrison St., WARSAW |
State: | IN |
Postal Code: | 46580 |
Phone Number: | 5742677169 |
Fax Number: | 5742693995 |
NPI Enumeration Date: | 10/03/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | A1431R |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |