Provider Demographics
NPI:1235525189
Name:WIRICK, ABBY
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:
Last Name:WIRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9168 LAKE FISCHER BLVD
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-5201
Mailing Address - Country:US
Mailing Address - Phone:407-415-0222
Mailing Address - Fax:
Practice Address - Street 1:9168 LAKE FISCHER BLVD
Practice Address - Street 2:
Practice Address - City:GOTHA
Practice Address - State:FL
Practice Address - Zip Code:34734-5201
Practice Address - Country:US
Practice Address - Phone:407-415-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health