Provider Demographics
NPI:1033977640
Name:WITCHER, VICKI KAMILLE (LCSWA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:KAMILLE
Last Name:WITCHER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 TARAS TRACE DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8296
Mailing Address - Country:US
Mailing Address - Phone:336-965-0802
Mailing Address - Fax:
Practice Address - Street 1:6347 ST PETERS CHURCH RD
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8862
Practice Address - Country:US
Practice Address - Phone:704-827-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO157541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical