Provider Demographics
NPI:1528146057
Name:WICE, ARLENE JANET (MED MA)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:JANET
Last Name:WICE
Suffix:
Gender:F
Credentials:MED MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3145 HENDERSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5603
Mailing Address - Country:US
Mailing Address - Phone:770-642-3488
Mailing Address - Fax:770-270-5255
Practice Address - Street 1:2175 NORTHLAKE PKWY
Practice Address - Street 2:STE 130 BLDG 4
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4105
Practice Address - Country:US
Practice Address - Phone:770-642-3488
Practice Address - Fax:770-270-5255
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001258103TC1900X
GA000785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist