Individual
JOHNATHAN TYROME WICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLBSW
Contact information
Practice address
420 W 5TH AVE, FLINT, MI 48503-2445
(181) 025-7373
Mailing address
420 W 5TH AVE, FLINT, MI 48503-2445
(181) 025-7373
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802087026
MI
Other
Enumeration date
06/05/2013
Last updated
06/05/2013
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