Provider Demographics
NPI:1619945003
Name:WIRICK, CARRIE L (LPCC , LICDC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:WIRICK
Suffix:
Gender:F
Credentials:LPCC , LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MCKINLEY PARK DR
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6399
Mailing Address - Country:US
Mailing Address - Phone:740-383-7840
Mailing Address - Fax:740-383-7816
Practice Address - Street 1:1000 MCKINLEY PARK DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6399
Practice Address - Country:US
Practice Address - Phone:740-383-7840
Practice Address - Fax:740-383-7816
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH923226101YA0400X
OHE0002304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000000334174OtherANTHEM BLUE CROSS/BLUE SH
OH6564038OtherCIGNA
OH6245047OtherUNITED BEHAVIORAL HEALTH