Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor |
NPI | 1003072653 |
---|---|
Provider Name | Natalie L Wicker |
First Address | Cheshire, CT 06410-3110 |
Second Address | New Britain, CT 06051-2132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 22/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004235918 | (05) | CT |