Individual
DR. DAVID LEE WICKSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Contact information
Practice address
7520 MONTICELLO RD, COLUMBIA, SC 29203-1516
(803) 254-3313
(803) 254-0370
Mailing address
420 LONGTOWN RD W, BLYTHEWOOD, SC 29016-9450
(803) 318-2009
(803) 691-9298
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0591
SC
Other
Enumeration date
01/18/2007
Last updated
07/08/2007
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