Individual
AUTUMN WICKERSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
836 W SOUTH BOUNDARY ST, PERRYSBURG, OH 43551
(419) 874-3201
Mailing address
26609 AMBERWOOD DR, PERRYSBURG, OH 43551
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1500510
OH
Other
Enumeration date
08/01/2016
Last updated
08/01/2016
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