Provider Demographics
NPI:1225845928
Name:WICKS PSYCHOTHERAPY
Entity type:Organization
Organization Name:WICKS PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:EVONNE
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LPC
Authorized Official - Phone:202-455-4550
Mailing Address - Street 1:1050 30TH ST NW STE 221
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3822
Mailing Address - Country:US
Mailing Address - Phone:202-455-4550
Mailing Address - Fax:
Practice Address - Street 1:1050 30TH ST NW STE 221
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3822
Practice Address - Country:US
Practice Address - Phone:202-455-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty