Individual
CARRIE WICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, ATR
Contact information
Practice address
1128 BIRCH DR, PETALUMA, CA 94952-1807
(707) 763-4278
Mailing address
1128 BIRCH DR, PETALUMA, CA 94952-1807
(707) 763-4278
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
17154
CA
Other
Enumeration date
10/27/2006
Last updated
07/08/2007
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