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NPI Code Detail

MEDICARE: HOLLY R WICKHAM LMSW, LCSW

MEDICARE: HOLLY R WICKHAM LMSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC016262NC
21041C0700XClinical Social Worker6801113476MI

General Provider Information

NPI Number : 1972273746
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY R WICKHAM LMSW, LCSW
Provider Business Mailing Address
First Line : 216 HATCHER CIR UNIT 210
Second Line :
City : ASHEVILLE
State : NC
Zip : 28806-0498
Country : US
Telephone Number : 239-848-2087
Fax Number :
Provider Business Practice Location Address
First Line : 550 STEPHENSON HWY STE 200
Second Line :
City : TROY
State : MI
Zip : 48083-1132
Country : US
Telephone Number : 239-848-2087
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2021
Last Update Date : 11/03/2023

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