Individual
BRENT WICKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3131 RDU CENTER DR STE 135, MORRISVILLE, NC 27560-7687
(984) 849-4447
Mailing address
3131 RDU CENTER DR STE 135, MORRISVILLE, NC 27560-7687
(984) 849-4447
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-76014
NC
Other
Enumeration date
03/26/2018
Last updated
10/10/2024
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