Healthcare Provider Details

I. General information

NPI: 1356917397
Provider Name (Legal Business Name): KIMBERLEY M. WICKER LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 KNOX ABBOTT DR STE 400
CAYCE SC
29033-4444
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7725
US

V. Phone/Fax

Practice location:
  • Phone: 843-501-1099
  • Fax: 843-405-2040
Mailing address:
  • Phone: 843-501-1099
  • Fax: 843-405-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17601
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: