Individual
DIANE HAYWARD WICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
26300 OUTER DR., LINCOLN PARK, MI 48146
(313) 388-4630
(313) 388-0472
Mailing address
26300 OUTER DR., LINCOLN PARK, MI 48146
(313) 388-4630
(313) 388-0472
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401002692
MI
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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