Individual
MR. ROBERT LEE WICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12399131
WI
101YP2500X
Professional Counselor
2430-123
WI
1041C0700X
Clinical Social Worker
Primary
2430123
WI
106H00000X
Marriage & Family Therapist
177124
WI
Other
Enumeration date
12/28/2006
Last updated
05/02/2012
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