Individual
MRS. CHRISTINA C WICKLIFFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
400 CUNNINGHAM WAY, BUILDING 1, DANVILLE, KY 40422-8342
(859) 936-3537
(502) 538-1189
Mailing address
400 CUNNINGHAM WAY, DANVILLE, KY 40422-8342
(859) 936-3537
(502) 538-1189
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
252431
KY
1041C0700X
Clinical Social Worker
Primary
252431
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100470410
—
KY
Enumeration date
11/17/2010
Last updated
09/26/2018
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