Provider Demographics
NPI:1093796492
Name:TRICO CORPORATION
Entity Type:Organization
Organization Name:TRICO CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TRICO CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:ARICK
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV LCPC NCC ACS
Authorized Official - Phone:301-862-4961
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:TRICO CORPORATION
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-0826
Mailing Address - Country:US
Mailing Address - Phone:301-862-4961
Mailing Address - Fax:301-373-4657
Practice Address - Street 1:2670 CRAIN HIGHWAY SUITE 525
Practice Address - Street 2:SMALLWOOD BLDG
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601
Practice Address - Country:US
Practice Address - Phone:301-632-2100
Practice Address - Fax:301-632-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407LMedicare ID - Type Unspecified
DCG01516Medicare ID - Type Unspecified