Provider Demographics
NPI:1225845928
Name:WICKS PSYCHOTHERAPY
Entity type:Organization
Organization Name:WICKS PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:EVONNE
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LPC
Authorized Official - Phone:202-455-4550
Mailing Address - Street 1:5425 WISCONSIN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3588
Mailing Address - Country:US
Mailing Address - Phone:202-455-4550
Mailing Address - Fax:
Practice Address - Street 1:5425 WISCONSIN AVE STE 600
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3588
Practice Address - Country:US
Practice Address - Phone:202-455-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty