Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LH60461035 | WA |
NPI | 1003207705 |
---|---|
Provider Name | Dr. Tonica Wicker |
First Address | Everett, WA 98201-2723 |
Second Address | Lake Stevens, WA 98258-7393 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2015 |
Last Update Date | 17/02/2015 |