Provider Demographics
NPI:1194800771
Name:WICKHAM, SHARON J (LCSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:WICKHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:J
Other - Last Name:PATTISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:921 FIRST COLONIAL RD STE 1711
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3167
Mailing Address - Country:US
Mailing Address - Phone:757-428-7500
Mailing Address - Fax:757-428-7699
Practice Address - Street 1:921 FIRST COLONIAL RD STE 1711
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3167
Practice Address - Country:US
Practice Address - Phone:757-428-7500
Practice Address - Fax:757-428-7699
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V768F27Medicare ID - Type Unspecified