Healthcare Provider Details

I. General information

NPI: 1952181562
Provider Name (Legal Business Name): CAITLIN WICK LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CREIGHTON ST FL 1
PROVIDENCE RI
02906-1518
US

IV. Provider business mailing address

9 CREIGHTON ST FL 1
PROVIDENCE RI
02906-1518
US

V. Phone/Fax

Practice location:
  • Phone: 202-930-2335
  • Fax:
Mailing address:
  • Phone: 202-930-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC16846
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01968
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRCC200012526
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: