Healthcare Provider Details

I. General information

NPI: 1619945003
Provider Name (Legal Business Name): CARRIE L WIRICK LPCC , LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MCKINLEY PARK DR 1ST FLOOR
MARION OH
43302-6399
US

IV. Provider business mailing address

1000 MCKINLEY PARK DR 1ST FLOOR
MARION OH
43302-6399
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-7840
  • Fax: 740-383-7816
Mailing address:
  • Phone: 740-383-7840
  • Fax: 740-383-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number923226
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0002304
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: