Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY8407 | CA |
N | 103T00000X | Psychologist | PSY8407 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY8407 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY8407 | CA |
N | 103G00000X | Clinical Psychologist | PSY8407 | CA |
N | 103TC0700X | Clinical Psychologist | PSY8407 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY8407 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY8407 | CA |
NPI | 1255473211 |
---|---|
Provider Name | Dr. Terrill Sharon Levinson Wickham |
First Address | Redlands, CA 92374-2895 |
Second Address | Redlands, CA 92374-2895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |