Provider Demographics
NPI:1386801827
Name:WICKER, DANA ABERNATHY (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:ABERNATHY
Last Name:WICKER
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-1725
Mailing Address - Country:US
Mailing Address - Phone:817-457-6728
Mailing Address - Fax:817-451-7732
Practice Address - Street 1:2912 LITTLE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-1725
Practice Address - Country:US
Practice Address - Phone:817-457-6728
Practice Address - Fax:817-451-7732
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31269103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling