Provider Demographics
NPI:1326602855
Name:ERICA A WICKE M.A. LICENSED MARRIAGE AND FAMILY THERAPIST INC.
Entity Type:Organization
Organization Name:ERICA A WICKE M.A. LICENSED MARRIAGE AND FAMILY THERAPIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WICKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:714-273-8580
Mailing Address - Street 1:2019 W CRESTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1303
Mailing Address - Country:US
Mailing Address - Phone:714-273-8580
Mailing Address - Fax:
Practice Address - Street 1:1403 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3803
Practice Address - Country:US
Practice Address - Phone:714-273-8580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty