Individual
COREY ELIZABETH WICEVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5121 KINGDOM WAY STE 100, RALEIGH, NC 27607-6063
(828) 236-1547
Mailing address
22 ASCENSION DR APT L, ASHEVILLE, NC 28806-1950
(815) 931-3529
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
NC
Enumeration date
01/07/2022
Last updated
01/07/2022
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