Provider Demographics
NPI:1306737135
Name:VICKERS, JUANITA (CSW LCSW C-ASWCM)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:VICKERS
Suffix:
Gender:X
Credentials:CSW LCSW C-ASWCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 STATE HIGHWAY 319
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:KY
Mailing Address - Zip Code:41531-8706
Mailing Address - Country:US
Mailing Address - Phone:606-369-4230
Mailing Address - Fax:
Practice Address - Street 1:2954 BUFFALO CREEK RD.
Practice Address - Street 2:
Practice Address - City:CHATTAROY
Practice Address - State:WV
Practice Address - Zip Code:25667
Practice Address - Country:US
Practice Address - Phone:304-792-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor