Individual
MARK DARWYNE VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2121 BEVERLY HILLS ST, NORMAN, OK 73072-5722
(405) 476-6597
Mailing address
2121 BEVERLY HILLS ST, NORMAN, OK 73072-5722
(405) 476-6597
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2366
OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
OK
Enumeration date
10/23/2009
Last updated
10/23/2009
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