Provider Demographics
NPI:1376307280
Name:WIKE-MEDLIN, ALLISON NOEL (LPCA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:NOEL
Last Name:WIKE-MEDLIN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FALL ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28137-5783
Mailing Address - Country:US
Mailing Address - Phone:336-991-6284
Mailing Address - Fax:
Practice Address - Street 1:106 FALL ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:NC
Practice Address - Zip Code:28137-5783
Practice Address - Country:US
Practice Address - Phone:336-991-6284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional