Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003189341 |
---|---|
Provider Name | Mrs. Kathleen Louise Wickham |
First Address | Santa Barbara, CA 93101-1664 |
Second Address | Santa Barbara, CA 93101-1664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2012 |
Last Update Date | 16/02/2012 |