Provider Demographics
NPI:1548667462
Name:WICE, SARAH FAYE (PHD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:FAYE
Last Name:WICE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:FAYE
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4660 MARSH RD STE 28
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2143
Mailing Address - Country:US
Mailing Address - Phone:517-898-0005
Mailing Address - Fax:517-347-7892
Practice Address - Street 1:4660 MARSH RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2143
Practice Address - Country:US
Practice Address - Phone:517-898-0005
Practice Address - Fax:517-347-7892
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015416103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist