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Individual

KATY RUTH VICKERS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1450 SE VESTHAVEN CIR, PORT SAINT LUCIE, FL 34952-8816
(772) 801-4649
Mailing address
PO BOX 2721, FORT PIERCE, FL 34954-2721

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Enumeration date
05/31/2017
Last updated
05/31/2017
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