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Individual
RAINA WICKHAM
Active
Individual
RAINA WICKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11-12-75
OR
101YM0800X
Mental Health Counselor
Primary
MASTERS - PSU
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500658765
—
OR
Enumeration date
10/15/2009
Last updated
11/08/2016
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