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General NPI Number Information
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NPI Number | 1306737135
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Entity Type | Individual
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Provider Name | JUANITA VICKERS CSW LCSW C-ASWCM
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Gender |
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 2954 BUFFALO CREEK RD.
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City | CHATTAROY
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State | WV
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Zip | 25667
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Country | US
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Telephone | 304-792-7130
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Fax |
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Provider Business Mailing Address
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Address Line | 1657 STATE HIGHWAY 319
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City | HARDY
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State | KY
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Zip | 41531-8706
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Country | US
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Telephone | 606-369-4230
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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