Individual
MRS. MELISSA D. WICKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LCPC
Contact information
Practice address
1600 LEBANON AVE, SUITE 108, BELLEVILLE, IL 62221-2491
(618) 444-1331
(618) 234-7003
Mailing address
1600 LEBANON AVE, SUITE 108, BELLEVILLE, IL 62221-2491
(618) 444-1331
(618) 234-7003
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
180.005608
IL
101YP2500X
Professional Counselor
180.005608
IL
106H00000X
Marriage & Family Therapist
Primary
180.005608
IL
Other
Enumeration date
06/26/2013
Last updated
06/26/2013
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