Individual
TINA WICKERSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC TEMP
Contact information
Practice address
4323 VINE AVE, SIOUX CITY, IA 51106-1958
(712) 202-0777
(712) 202-0780
Mailing address
4323 VINE AVE, SIOUX CITY, IA 51106-1958
(712) 202-0777
(712) 202-0780
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
084138
IA
Other
Enumeration date
08/17/2016
Last updated
08/17/2016
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