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General NPI Number Information
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NPI Number | 1427588060
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Entity Type | Individual
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Provider Name | DANIEL WICK
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Gender | Male
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 1 ELIZABETH PL STE 190
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City | DAYTON
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State | OH
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Zip | 45417-3445
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Country | US
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Telephone | 937-652-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 4751 FISHER TWIN RD
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City | WEST ALEXANDRIA
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State | OH
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Zip | 45381-8309
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.0003656-SUPV
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License Number State | OH
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