Provider Demographics
NPI:1275970154
Name:DICICCO-WILES, JULIANNE (MS, CPS, ICPS)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:
Last Name:DICICCO-WILES
Suffix:
Gender:F
Credentials:MS, CPS, ICPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6439
Mailing Address - Country:US
Mailing Address - Phone:843-871-4790
Mailing Address - Fax:843-871-8579
Practice Address - Street 1:500 N MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6439
Practice Address - Country:US
Practice Address - Phone:843-871-4790
Practice Address - Fax:843-871-8579
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst