Provider Demographics
NPI:1972273746
Name:WICKHAM, HOLLY R (LMSW, LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:R
Last Name:WICKHAM
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 HATCHER CIR UNIT 210
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-0498
Mailing Address - Country:US
Mailing Address - Phone:239-848-2087
Mailing Address - Fax:
Practice Address - Street 1:550 STEPHENSON HWY STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1132
Practice Address - Country:US
Practice Address - Phone:239-848-2087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0162621041C0700X
MI68011134761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical